Examining All Possible Causes Behind Intestinal Ischemia in Newborns

What is ischemia and what are some of the possible causes that are causing health problems in newborns?

Also referred to as bowel ischemia and mesenteric ischemia, intestinal ischemia is a rare condition that strikes at the very core of our body’s ability to function. 

Picture a vital network of blood vessels delicately supplying oxygen-rich blood to your intestines. Now imagine that flow disrupted, leading to a cascade of potentially devastating consequences. 

Intestinal ischemia occurs when the blood flow to your intestines is restricted or compromised, resulting in a decreased supply of oxygen to the intestinal tissues. This leads to tissue damage, necrosis (tissue death), and even perforation of the intestines, which can result in life-threatening infections and systemic complications.

A review published in JAMA network explains the acute version of this condition to be “a life-threatening vascular emergency,” with its overall mortality rate falling between 60-80%. 

It was also revealed in the review that the survival rate for the condition hasn’t improved substantially in the last 70 years. The prime reason behind it is the continued difficulty in recognizing the condition before it becomes fatal.

This article is focused on examining intestinal ischemia in newborns and exploring all possible causes behind it. 

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Understanding Intestinal Ischemia in Newborns

Intestinal ischemia in newborns is a critical and often life-threatening condition that presents unique challenges in its diagnosis and management. Unlike in adults, the causes and consequences of intestinal ischemia in newborns can be vastly different.

Newborns, with their fragile bodies and developing organs, are particularly vulnerable to disruptions of any kind in their blood flow. Intestinal ischemia is triggered by a decreased blood supply to your newborn’s intestines, which can potentially cause tissue damage, necrosis, and other severe complications.

A number of factors – ranging from congenital anomalies to acquired disorders and infections – can cause ischemia in newborns. Malrotation, necrotizing enterocolitis (NEC), and congenital heart defects are just a few examples of conditions that can predispose newborns to intestinal ischemia.

Because the clinical presentation of intestinal ischemia in newborns is generally subtle and nonspecific, it is a challenging task to diagnose it early. Its primary symptoms – such as abdominal distension, feeding intolerance, vomiting, and bloody stools – can easily be confused for other common neonatal conditions. This, in turn, makes the diagnosis even more complicated. 

Possible Causes of Intestinal Ischemia in Newborns

Having grasped the fundamental understanding of intestinal ischemia in newborns above, we will now proceed to examine the causes behind this rare condition:

Necrotizing Enterocolitis (NEC) 

Necrotizing Enterocolitis (NEC) is a serious condition that affects the intestines of newborn babies, especially those born prematurely. Simply put, it’s when parts of the intestines become inflamed and damaged. This inflammation can cause the death of intestine tissues, leading to a lack of blood flow, which is what we mean by “ischemia”.

This lack of blood flow means the affected parts of the intestine aren’t getting the oxygen and nutrients they need to stay healthy. Without treatment, the tissue can start to die off, and the condition can get worse quickly.

To add to its severity, NEC has become increasingly common among babies. A 2023 NIH study reveals that the incidence of NEC worldwide varies between 0.3 to 2.4 infants per 1000 live births. According to the study, 70% these cases occur in premature infants, born before 36 weeks gestation. It also highlights genetic factors as a primary risk for the condition. 

NEC often starts with the lining of the intestines becoming irritated or injured. This can happen because the baby’s intestines are sensitive, especially if they’re not fully developed. Sometimes, the exact cause isn’t clear, but factors like formula feeding instead of breast milk, infections, or problems with blood flow can contribute to NEC.

TorHoerman Law notes how several studies published in 2017 have highlighted the link between bovine-based baby formulas and the risk of NEC in babies.

Recently, several baby formula manufacturing brands have been known to cause NEC in newborns. Enfamil – manufactured by Mead Johnson – and Similac – manufactured by Abbott – are two of them to have been named. 

In May 2021, an NEC baby formula lawsuit was filed against these brands by a woman from Louisiana. Her son, born prematurely, was fed the formula from these brands and subsequently developed NEC. Since then, over 400 other parents have joined her claim. If your newborn has suffered the same fate, you can join it, too. 

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Congenital Anomalies 

Congenital anomalies or disorders are basically issues that a baby is born with, often because something went a bit wonky during pregnancy.

Congenital disorders affect newborns on a wide scale. WHO notes that it results in the death of 240,000 newborns within the first 4 weeks of their birth every year. Among children between 1 month to 5 years of age, 170,000 lose their lives to this condition.

 In the context of intestinal ischemia in newborns, congenital anomalies can affect the way the intestines are formed or how they work.

Malrotation is an example of a congenital anomaly where the intestines don’t twist into their proper position while the baby is still developing in the womb. 

This abnormal twisting can lead to a blockage of the blood vessels that supply the intestines. As the blood flow is blocked or reduced, it can cause ischemia, creating a deficiency of oxygen and nutrients in their tissues.

Another example is intestinal atresia, where parts of the intestines are missing or blocked off. This can disrupt the normal blood flow to their intestines, leading to ischemia.

Cardiovascular Conditions

In newborns, congenital heart defects are often the main cardiovascular conditions that contribute to intestinal ischemia. 

These problems with the structure of the heart that are present at birth. When the heart doesn’t pump blood effectively or if there are abnormalities in the blood vessels, it can affect blood flow to various parts of the body, including the intestines.

When the heart isn’t pumping blood as it should, it means less blood is getting to the intestines, which can lead to ischemia. 

Similarly, if there are problems with the blood vessels supplying the intestines, such as blockages or narrowing, it can restrict blood flow and cause ischemia.

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Infections can be a sneaky cause of intestinal ischemia in newborns. When babies get infections, their little bodies can react in ways that mess with blood flow to their intestines.

One common infection that can lead to intestinal ischemia is sepsis. This is when bacteria or other germs get into the bloodstream and cause a widespread infection throughout the body. 

When your baby’s body is fighting off an infection like sepsis, it can lead to problems with blood pressure and blood flow, affecting the blood supply to the intestines. If the blood flow to the intestines is reduced, it can cause parts of the intestines to not get enough oxygen and nutrients, resulting in ischemia.

Certain viral infections can also cause inflammation and damage to the intestines, which can affect blood flow.

Rotavirus, for instance, is a common gastroenteritis-causing viral infection, whch leads to the inflammation of the stomach and intestines. This inflammation can obstruct the blood flow to the intestines, potentially causing ischemia.

Frequently Asked Questions (FAQs)

How is intestinal ischemia diagnosed in newborns?

Intestinal ischemia is primarily diagnosed in newborns by a thorough physical examination by their healthcare provider. In some cases, they may even recommend some blood tests to rule out the possibility of infections. When a closer examination of your baby’s bowel is required, it can call for imaging studies as well. 

Can intestinal ischemia in newborns be prevented?

An early and regular prenatal care is paramount for preventing your newborn from the risk of intestinal ischemia. Moreover, other cautionary measures involve promoting healthy birthing practices to reduce the risk of birth trauma and avoiding unnecessary interventions during labor. 

Are there any long-term effects of intestinal ischemia in newborns?

Yes, intestinal ischemia can do lasting damage to your newborn’s overall health. From leading to developmental delays to causing chronic digestive issues, it can create a wide of health problems for them. Certain severe cases of ischemia have also been known to cause permanent brain damage by interfering with the brain’s oxygen supply.

To wrap it up, intestinal ischemia is no ordinary problem that your newborn can simply outgrow with certain medications. It is a serious health concern that requires urgent and appropriate medical attention to treat and can lead to disastrous outcomes in its absence.

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