Effect of Oral N-Acetyl Cysteine in Prevention of Necrotizing Enterocolitis in Preterm Neonates with Feeding Intolerance

Abstract Background Necrotizing enterocolitis (NEC) is one of the most challenging diseases in neonates. Prematurity alone is believed to be a major risk factor for NEC. Feeding intolerance can be the first clinical presentation of NEC, it can progress rapidly into fulminating disease. Therefore, identification of new strategies for prevention of NEC is needed. Objective The aim of this study was to evaluate the preventive effect of enteral N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in preterm neonates with feeding intolerance. Patient and Methods The study was a double blinded randomized controlled trial that was conducted on preterm neonates with feeding intolerance at Neonatal intensive care unit (NICU) department, Ain Shams University. Hundred and eight preterm neonates with feeding intolerance were randomly divided into two groups, intervention group and control group. The intervention group received enteral NAC by a dose (20mg/kg/6h) while the control group received placebo distilled water (1cc/6h) for either 10 days or when all signs and symptoms of feeding intolerance resolve, whichever comes first. Both groups were monitored clinically for improvement or progression to NEC. Results Our findings showed that there was a significant decrease in the incidence of NEC in the intervention group, who received enteral NAC, in comparison to the control group (n = 8 vs n = 26), with p value (<0.01). As well as significant reduction in the time needed to reach half, two-third and full enteral feeding, in the intervention group in comparison to the control group. Conclusion Enteral administration of N-acetylcysteine might reduce the incidence of NEC in preterm neonates with feeding intolerance.