Fig. 9: Remote ischemic conditioning counteracts the intestinal damage of necrotizing enterocolitis (NEC) by improving intestinal microcirculation.

Prematurity and formula feeding are among the main risk factors contributing to the development of NEC, a devastating disease of premature infants characterized by intestinal inflammation and ischemia. NEC is characterized by derangements in intestinal microcirculatory blood flow, villus core separation, sloughing of the villi, and presence of necrotic tissue at the villi. Remote ischemic conditioning is a therapeutic maneuver whereby application of brief cycles of ischemia and reperfusion to a limb protects a distant organ from sustained ischemic damage. During the initial stage of experimental NEC, remote ischemic conditioning improves intestinal injury, reduces inflammation, and enhances survival. The mechanism of action of remote ischemic conditioning involves preservation of intestinal microcirculation that is mediated by the vasodilators, hydrogen sulfide and nitric oxide. Remote ischemic conditioning is a noninvasive treatment strategy for neonatal NEC.