Predicting and Preventing Necrotizing Enterocolitis:
Melissa Halpern, PhD, associate professor, measures bile acid levels in premature babies to predict and prevent Necrotizing Enterocolitis (NEC), an intestinal disease that is fatal to nearly one in five infants who develop the most severe form. NEC is a potentially deadly inflammatory gastrointestinal disease that afflicts approximately 9,000 premature infants in the United States every year. The cause is unknown and no treatments for the disease exist. In severe cases, a child’s inflamed intestines may tear or perforate, allowing bacteria to leak into the abdomen, possibly causing life-threatening sepsis. Portions of the intestines may require surgery to remove the damaged areas. Unfortunately, many children who survive surgical intervention face lifelong digestive difficulties.
Dr. Halpern hypothesizes this fluctuation in bile acid levels can be used to predict if a premature infant will develop NEC. “Currently, there are no means to determine which infants are likely to develop the disease,” said, Dr. Halpern.
Bile acids, a normal component of digestion, are produced in the liver to break down fats for digestion and can be measured in fecal material.
“However, accumulation of bile acids within cells can be destructive, which is why there is a complicated process that moves bile acids in and out of cells,” Dr. Halpern explained. “This process also controls the amount of bile acids produced. In NEC, we believe the process of bile acid transport is faulty, allowing the bile acids to accumulate within intestinal cells, which leads to cellular injury. Enough injury and the tissue eventually is destroyed.”
To obtain a reliable sample size, fecal material will be collected from approximately 200 premature infants from hospitals in Phoenix. Once collected, fecal bile acid levels will be determined and correlated with the type and amount of feeding, gestational age and baby’s birth weight.
“Knowing which babies are at highest risk could lead to significantly fewer developing this devastating disease,” Dr. Halpern said. “And while NEC can be deadly for premature infants who are already weakened, early, aggressive treatment saves lives.”