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Intestinal alkaline phosphatase prevents the systemic inflammatory response associated with necrotizing enterocolitis

  • Sundeep G. Keswani
    Correspondence
    Corresponding author. Division of General, Thoracic, and Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. Tel.: +513 803 1632; fax: +513 636 2735.
    Affiliations
    Division of General, Thoracic, Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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  • Alice King
    Affiliations
    Division of General, Thoracic, Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Published:February 11, 2013DOI:https://doi.org/10.1016/j.jss.2013.01.041
      Necrotizing enterocolitis (NEC) represents a heterogeneous group of pathologic processes in the intestines of neonates who are commonly premature with very low birth weights. It is characterized by an intense inflammatory response and has mortality rates as high as 20%–40% [
      • Kliegman R.M.
      • Walker W.A.
      • Yolken R.H.
      Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis.
      ,
      • Meinzen-Derr J.
      • Morrow A.L.
      • Hornung R.W.
      • et al.
      Epidemiology of necrotizing enterocolitis temporal clustering in two neonatology practices.
      ]. Despite the established relationship between necrotizing enterocolitis and a proinflammatory cascade, the pathophysiology is still not completely understood. The involvement of enteral feedings, compromised intestinal perfusion, and bacterial invasion are commonly accepted factors [
      • Kosloske A.M.
      Epidemiology of necrotizing enterocolitis.
      ]. There has been significant research into the pathophysiology of NEC; however, there have been few major advances in its treatment. The mainstay of medical treatment continues to be stabilization with bowel rest, gastrointestinal decompression, parenteral nutrition, and antibiotics [
      • Lee J.S.
      • Polin R.A.
      Treatment and prevention of necrotizing enterocolitis.
      ]. Further therapeutic strategies are much less well defined.
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