David Hackam’s laboratory focuses on necrotizing enterocolitis (NEC), a devastating disease of premature infants and the leading cause of death and disability from gastrointestinal disease in newborns.

We invite parents and families of children facing complex conditions or illnesses to use this site as an informational resource. We also welcome investigators seeking to collaborate with us and individuals who may be interested in joining our growing team.

Understanding NEC

NEC strikes acutely and without warning, causing sudden death of the small and large intestines. In severe cases, tiny patients with the disease are either dying or dead from overwhelming sepsis within 24 hours. Surgical treatment to remove most of the affected gut results in lifelong short gut (short bowel) syndrome.

The typical infant with necrotizing enterocolitis is a relatively stable premature baby who suddenly develops feeding intolerance, abdominal pain and abdominal distention, and, in severe cases, is either dying or dead from overwhelming sepsis within 24 hours. If these tiny patients undergo surgery, extensive death of the small and large intestines is encountered. Current treatment is effective in only about one-half of patients, and it involves the use of broad-spectrum antibiotics and resection (removal) of the dead intestine.

Our lack of understanding of the precise pathogenesis of necrotizing enterocolitis is highlighted by the fact that overall survival has not improved significantly in the past 30 years, when the disease was first described.

Why is necrotizing enterocolitis an important priority?

• Necrotizing enterocolitis is the most common cause of death in premature infants.
• Between 10 and 12 percent of premature infants born prior to 36 weeks are stricken with necrotizing enterocolitis.
• Necrotizing enterocolitis affects one in 500 live births.
• There is currently no real treatment, and doctors do not yet know the cause.

What are the global public health impacts of necrotizing enterocolitis?

Premature births are increasing all over the world. This means that necrotizing enterocolitis, which is more common in premature infants, is also on the rise.

The cost to patients and to society, including lifelong medical care and loss of productivity, is between $1 billion and $2 billion per year in the U.S. alone.

What else does necrotizing enterocolitis affect?

Those who survive necrotizing enterocolitis may suffer from cognitive, motor and lung impairment; these are areas of active investigation in the Hackam Lab.

Lab Discovery and Investigation Highlights

Identifying a Key Protein

The Hackam Lab has identified a critical role for the innate immune receptor toll-like receptor 4 (TLR4) in the pathogenesis of necrotizing enterocolitis. The lab has shown that TLR4 regulates the development of the disease by tipping the balance between injury and repair in the stressed intestine of the premature infant.

Developing an Artificial Intestine

A key goal is to create, in the laboratory, new intestines made from patients’ own cells, which can then be implanted into the patient to restore normal digestive function. This innovative design could transform child development and quality of life in necrotizing enterocolitis survivors without the risks of conventional donor transplant.