vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v23i6.2830vsp-3652Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWНекротизирующий энтероколит: особенности патогенеза и дифференциальная диагностика с воспалительными заболеваниями кишечника у новорожденныхNecrotizing Enterocolitis: Pathogenetic Features and Differential Diagnosis with Inflammatory Bowel Disease in Newbornshttps://orcid.org/0000-0001-6939-6961КаплинаА. В.KaplinaAleksandra V.

Каплина Александра Владимировна - младший научный сотрудник научно-исследовательской лаборатории физиологии и патологии новорожденных Института перинатологии и педиатрии, врач-неонатолог отделения физиологии новорожденных с палатой интенсивной терапии Клиники материнства и детства Перинатального центра

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Санкт-Петербург

St. Petersburg

kaplinashi@gmail.comhttps://orcid.org/0000-0002-0479-0850ПетроваН. А.PetrovaNataliya A.

Санкт-Петербург

 St. Petersburg

https://orcid.org/0000-0001-9948-7303ПервунинаТ. М.PervuninaTatiana M.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-7308-7280ХавкинА. И.KhavkinAnatoly I.

 Москва

Белгород

Moscow

Belgorod

https://orcid.org/0000-0002-3697-4283СурковА. Н.SurkovAndrey N.

Москва

Moscow

https://orcid.org/0009-0000-1480-6564НазаренкоЛ. И.NazarenkoLyudmila P.

Санкт-Петербург

St. Petersburg

https://orcid.org/0009-0004-1751-1293ГетмановС. Д.GetmanovStanislav D.

Москва

Moscow

https://orcid.org/0000-0003-0331-0963СиткинС. И.SitkinStanislav I.

Санкт-Петербург

St. Petersburg

НМИЦ им. В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian FederationНИКИ детства; БелГУРоссияResearch Clinical Institute of Childhood; Belgorod National Research UniversityRussian FederationНИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»; РНИМУ им. Н.И. Пирогова (Пироговский Университет)РоссияResearch Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical UniversityRussian FederationСЗГМУ им. И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationРНИМУ им. Н.И. Пирогова (Пироговский Университет)РоссияPirogov Russian National Research Medical UniversityRussian FederationНМИЦ им. В.А. Алмазова; СЗГМУ им. И.И. Мечникова; Институт экспериментальной медициныРоссияAlmazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov; Institute of Experimental MedicineRussian Federation202402012025236438446Copyright © Каплина А.В., Петрова Н.А., Первунина Т.М., Хавкин А.И., Сурков А.Н., Назаренко Л.И., Гетманов С.Д., Ситкин С.И., 20242024Каплина А.В., Петрова Н.А., Первунина Т.М., Хавкин А.И., Сурков А.Н., Назаренко Л.И., Гетманов С.Д., Ситкин С.И.Kaplina A.V., Petrova N.A., Pervunina T.M., Khavkin A.I., Surkov A.N., Nazarenko L.P., Getmanov S.D., Sitkin S.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3652

Некротизирующий энтероколит (НЭК) — заболевание, поражающее преимущественно недоношенных новорожденных. В основе патогенеза НЭК лежит развитие воспалительного процесса с поражением слизистой оболочки кишки в условиях колонизации кишечника микрофлорой на фоне незрелости кишечного эпителия и регуляции кровообращения в кишечнике, чрезмерной активации воспалительного ответа. В неонатальном периоде также могут дебютировать воспалительные заболевания кишечника (ВЗК) с очень ранним началом (ОРН-ВЗК), которые характеризуются тяжелым течением, часто устойчивым к традиционной иммуносупрессивной терапии. В статье рассмотрены особенности патогенеза НЭК и его дифференциальной диагностики с ОРН-ВЗК. Несмотря на некоторые сходства патогенеза, НЭК и ВЗК являются разными заболеваниями. Инфантильные формы ВЗК чаще ассоциированы с моногенными заболеваниями, связанными с первичными иммунодефицитами. ОРН-ВЗК являются хроническими заболеваниями, характеризуются поражением всех слоев кишки, имеют меньшую частоту, чем НЭК; клиническими проявлениями могут являться хроническая диарея, примесь крови в стуле, задержка физического развития, перианальные заболевания, изъязвления в полости рта. Для инфантильной формы ОРН-ВЗК более характерно поражение толстой кишки, для НЭК недоношенных новорожденных — подвздошной кишки. Кишечный микробиом при ОРН-ВЗК также имеет специфические особенности. Представленные в литературе клинические случаи болезни Крона у пациентов, перенесших НЭК в неонатальном периоде, ассоциированы с хирургической стадией НЭК. При оценке риска ВЗК необходимо учитывать особенности перинатального периода (пренатальное воздействие антибактериальной терапии и курения, применение нескольких курсов антибактериальной терапии в течение первого года жизни; искусственное вскармливание)

Necrotizing enterocolitis (NEC) is a disease primarily affecting premature infants. NEC pathogenesis is based on the development of inflammation damaging mucous membranes associated with bacterial colonization, intestinal epithelium immaturity, intestinal blood flow regulation, and excessive inflammatory response activation. Inflammatory bowel disease (IBD) with very early onset (VEO-IBD) can also manifest in the neonatal period. They are characterized by severe course, often resistant to traditional immunosuppressive therapy. This article discusses the features of NEC pathogenesis and differential diagnosis with VEO-IBD. Despite certain similarities in pathogenesis, NEC and IBD are different diseases. Infantile onset IBD is more often associated with monogenic diseases and primary immunodeficiency. VEO-IBD is a chronic disease characterized by damage to all intestinal layers and has a lower incidence compared to NEC. Its clinical manifestations may include chronic diarrhea, blood in stool, delayed physical development, perianal diseases, and ulcerations in the oral cavity. Infantile onset VEO-IBD usually affects the colon, while NEC affects the ileum in premature infants. The intestinal microbiome in VEO-IBD also has specific features. It has been reported that clinical cases of Crohn’s disease in patients who had NEC in the neonatal period are associated with NEC surgery. It is crucial to consider perinatal period features when assessing the IBD risk (prenatal effects of antibacterial therapy and smoking, several courses of antibacterial therapy during the first year of life, and formula feeding).

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The authors declare that there are no conflicts of interest present.