LOWER INCIDENCE OF NECROTIZING ENTEROCOLITIS IN INFANTS FED A PRETERMFORMULA WITH EGG PHOSPHOLIPIDS

Necrotizing enterocolitis (NEC) causes approximately 4000 deaths/y and significant morbidity among U.S.-born preterm infants alone. Various combinations of inadequate tissue oxygenation, bacterial overgrowth, a nd enteral feeding with immaturity may cause the initial damage to int estinal mucosa that culminates in necrosis. Presently, there is not a way to predict the onset of the disease or to prevent its occurrence. As part of risk-benefit assessment, we compared disease in hospitalize d preterm infants fed a commercial (control) preterm formula or an exp erimental formula with egg phospholipids for a randomized, double-mask ed, clinical study of diet and infant neurodevelopment. Infants fed th e experimental formula developed significantly less stage Il and III N EC compared with infants fed the control formula (2.9 versus 17.6%, p < 0.05), but had similar rates of bronchopulmonary dysplasia (23.4 ver sus 23.5%), septicemia (26 versus 31%), and retinopathy of prematurity (38 versus 40%). Compared with the control formula, the experimental formula provided 7-fold more esterified choline, arachidonic acid (AA, 0.4% of total fatty acids), and docosahexaenoic acid (0.13%). Phospho lipids are constituents of mucosal membranes and intestinal surfactant , and their components, AA and choline, are substrates for intestinal vasodilatory and cytoprotective eicosanoids (AA) and the vasodilatory neurotransmitter, acetylcholine (choline), respectively. One or more o f these components of egg phospholipids may have enhanced one or more immature intestinal functions to lower the incidence of NEC in this st udy. Regardless of the potential mechanism, a larger randomized trial designed to test the effect of this egg phospholipid-containing formul a on NEC seems warranted.