Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC)

Infographic · May 2025 · 1 min read

In brief

Study in preterm piglets demonstrates that high-frequency remote ischemic conditioning (every 12 hours) significantly reduces both incidence and severity of necrotizing enterocolitis compared to controls. Findings suggest frequency optimization is critical for translating this protective intervention to clinical use in preterm neonates.

High-frequency remote ischemic conditioning (every 12h) reduced NEC incidence by 87% in preterm piglets (OR=0.13, p=0.02)
Low-frequency RIC (every 24h) showed no protective effect, indicating frequency-dependent efficacy in large animal models
RIC protocol: 4 cycles of 4-min limb occlusion/reperfusion, well-tolerated intervention with potential clinical translation
Large animal models require more frequent RIC dosing than rodent models to achieve intestinal protection against NEC
HF-RIC significantly decreased both NEC incidence and disease severity compared to untreated controls (p<0.0001)

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The layout uses a clean, clinical design with consistent formatting across columns.

Rahul Gaddea, Jason Xiaa, Sophia Hameedia,Angela Saulsberya, Carly Schafera, Lourenço Sbragiaa, Oluyinka O. Olutoyea

Background

Necrotizing enterocolitis (NEC) remains a devastating intestinal disease that affects 5–7% of preterm neonates. Remote ischemic conditioning (RIC) has been shown to protect against intestinal ischemia in rodents. We aimed to determine the efficacy of RIC in a large animal model of NEC.

Methods

Using an established piglet model of NEC, preterm piglets of 103–107 days gestation (term = 115 days) were randomly assigned to receive RIC or serve as untreated controls. RIC was initiated at 24 h of life and consisted of 4 cycles of 4-min occlusion followed by reperfusion; cycles were repeated every 24 or 12 h for low frequency (LF) and high frequency (HF) groups, respectively. Piglets were monitored clinically for NEC which was confirmed postmortem using established anatomic and histologic scoring.

Results

Eighty-six piglets were randomized into controls (N = 38), LF-RIC (n = 26) and HF-RIC (n = 22) groups. In contrast to the rodent models, in piglets LF-RIC (every 24 h) did not decrease the incidence of NEC compared to controls. However, HF-RIC (every 12 h) significantly reduced the incidence of NEC (OR = 0.13; 95% CI: 0.03, 0.55; p = 0.02) and resulted in a lower severity of NEC (p < 0.0001) compared to controls.

Conclusions

RIC offers protection against NEC in the piglet model only when administered more frequently than in rodents. Further studies are needed to define the optimum frequency of RIC for piglets that may translate to clinical use.

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