Minimização dos Riscos de Enterocolite Necrosante (NEC)
Ana Margarida Alexandrino
NEC é uma doença inflamatória intestinal do RN com grande morbilidade e
mortalidade no RN pré-termo. Atinge nas séries mais recentes entre 2 a 5% dos RN
MBP, mortalidade entre 15 a 30% e morbilidade importante de 10 a 30%, sendo a
principal causa de intestino curto.
Da via causal fazem invariavelmente parte nutrientes, bactérias e em quase 100% dos
casos a prematuridade, aos quais se junta muitas vezes a lesão hipoxico-isquémica.
São conhecidos já vários factores bioactivos, proinflamatórios, genéticos que
contribuem para a cascata de fenómenos que levam à necrose da mucosa; estão
também identificados factores protectores de imunomodulação bioactivos e que estão
invariavelmente presentes no leite materno – IgA secretoria, leucócitos, mucina,
lisozima, citoquinas, IL-10, lactoferrina, factores de crescimento EGF, PAF-AH, enzimas,
oligossacaridos e PUFA´s não disponíveis nas fórmulas não comerciais.
Das estratégias preventivas gerais de NEC fazem parte a redução da exposição a
factores de risco, tratamento pronto e eficaz da policitemia , a restrição hídrica
moderada e criteriosa, evitar a antibioterapia empírica inicial superior a 5 dias quando
desnecessária, evitar fórmulas hipertónicas e agentes de contraste, promover política
transfusional restritiva. Todas estas atitudes são no fundo medidas de boa prática.
Das estratégias específicas ( UpToDate 2013) constam os seguintes recomendações:
- Recomendação da Academia Americana de Pediatria (Grau 1A): Todos os pré-termos
devem receber leite materno.
-
Início do leite nos primeiros 2 a 5 dias de vida
-
Alimentação trófica mínima nos primeiros dias (até 10-20 ml/Kg/dia)
-
Aumentos muito graduais (15-25 ml/Kg/dia)
-
Fortificante do leite materno e suplemento proteico a partir dos 100
mL/Kg/dia
- Uso de probióticos deve ser, para já, limitado a ensaios clinicos (grau 2B)
- Evitar Bloqueadores Histamina 2 (grau 2B)
- O uso de Imunoglobulinas orais não está recomendado (grau 1B)
- O uso de arginina e glutamina não está recomendado (grau 1B).
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