Necrotizing enterocolitis.

Valmiki K. Seecheran.Year V | MBBS.

Introduction.

• Primarily seen in premature infants.• Portions of bowel under go necrosis.• 2ND most common cause of morbidity in

premature infants.

Signs & symptoms.

• Onset is generally inversely proportional to the gestational age of the baby at birth.– Earlier a baby is born, the later signs of NEC are

seen.• Feeding intolerance, increased gastric

residuals, abdominal distension, bloody stools.• May progress rapidly to abdominal distension

– intestinal perforation, peritonitis and systemic hypotension – requiring NICU.

Necrotizing enterocolitis.Radiograph of an infant with necrotizing enterocolitis

Closeup of intestine of infant showing necrosis and pneumatosis intestinalis.

Necrotizing enterocolitis.

Diagnosis.• Ultrasonography has also proven to be useful.• Bell’s Stage 1 – Suspected disease.

– Mild systemic disease. – bradycardia, apnoea, temperature instability.– Mild intestinal signs. – abdominal distension, gastric residuals, bloody stools.– Non-specific/ normal radiological signs.

• Bell’s Stage 2 – Definite disease.– Mild to moderate systemic signs.– Additional intestinal signs – absent bowel sounds, tenderness.– Specific radiologic signs – pneumatises intenstinalis.

• Bell’s Stage 3 – Advanced disease.– Severe systemic illness – hypotension.– Additional intestinal signs – abdominal distension, peritonitis.– Radiologic signs – pneumoperitoneum.– Additional laboratory changes – Acidosis, DIC.

Treatment.

• Primarily supportive care.– Enteral feeds, gastric decompression with intermittent suction,

fluid repletion to correct electrolyte abnormalities, parenteral nutrition and prompt antibiotic therapy.

• Monitoring is clinical.– Abdominal roentgenograms should be performed every 6

hours.• Bowel perforation.

– Emergency surgery to resect the dead bowel.– Colostomy – which may be able to be reserved at a later time.– Short bowel syndrome – malabsorption caused by the surgical

removal of small intestines.

Prevention.

• *American Academy of Pediatrics* recommended feeding preterm infants human milk, finding ‘’significant short – and long-term beneficial effects.’’

• Neonatologists at the *University of Iowa* reported on the importance of providing small amounts of trophic oral feeds of human milk starting as soon as possible, while the infant is being primarily fed intravenously, in order to prime the immature gut to mature and become ready to receive greater oral intake.

• A Cochrane review published in April 2014 has established that supplementation of probiotics enterally prevents severe NEC as well as all-cause mortality in preterm infants.

Prognosis.

• Typical recovery from NEC if medical, non surgical treatment succeeds, includes 10-14 days or more without oral intake and then demonstrated ability to resume feedings and gain weight.

• Long term prognosis for infants undergoing NEC surgery is improving, with survival rates of 70%-80%. Surgical NEC are at risk for complications including short bowel syndromes.

Thank you.