NECROTIZING ENTEROCOLITIS ELBW INFANTS
Category: Child Health
Abstract : Necrotizing enterocolitis NEC is a disease of the premature gastrointestinal
tract that represents injury to the intestinal mucosa and vasculature. Incidence
of NEC is associated with decreasing gestational age, and it is a dreaded
complication of premature birth. NEC accounts for 7.5% of all neonatal deaths.
Risk factors include asphyxia or any ischemic insult to the gastrointestinal
Necrotizing enterocolitis
NEC is a disease of the premature gastrointestinal
tract that represents injury to the intestinal mucosa and vasculature. Incidence
of NEC is associated with decreasing gestational age, and it is a dreaded
complication of premature birth. NEC accounts for 7.5% of all neonatal deaths.
Risk factors include asphyxia or any ischemic insult to the gastrointestinal
blood supply.
The role of enteral feeding is controversial. Breast milk may have
a protective effect but has not been shown to prevent NEC.
Presenting
symptoms may be vague and include apnea, bradycardia, and abdominal distention.
These symptoms can quickly progress to indicators of increasing sepsis, such as
large gastric residuals, metabolic acidosis, and lethargy. Radiographic findings
include stacked bowel loops, pneumatosis intestinalis (presence of gas in the
bowel wall), portal venous gas, and free air, which indicates perforation of the
bowel and is an ominous sign of impending deterioration. NEC usually presents
close to the time that the infant is taking full enteral feedings, usually
between the second and third weeks of life.
NEC is commonly managed with
antibiotics, elimination of oral intake, gastric decompression by nasogastric
tube, and supportive measures to correct complications such as metabolic
acidosis, thrombocytopenia, and hypotension.
Surgical intervention may be
necessary if evidence of perforation exists (presence of free air on
radiographs) or medical treatment fails. Long-term complications include those
related to bowel resection (short gut syndrome), bowel strictures, and risk of
abdominal adhesions.
Spontaneous bowel perforation often occurs in the
first week of life, presenting earlier than a typical case of NEC. Stark et al
showed a strong interaction between postnatal use of dexamethasone and
indomethacin on incidence of perforation (19%) in ELBW infants in a trial
designed to determine if a 10-day course of postnatal dexamethasone would reduce
the risk of CLD or death.
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