Necrotizing enterocolitis


Necrotizing enterocolitis

Description, Causes and Risk Factors:

Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) emergency in neonatal intensive care units (NICUs), making it one of the leading causes of long-term disability in preterm infants. NEC is called `the disease of survivors' as it is characteristically manifest in preterm infants, who have survived other immediate life-threatening complications associated with their very low birth weights (<1500 g), such as respiratory distress syndrome and congenital cardiac anomalies.

The exact cause of NEC is unknown, but one theory is that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow. So when feedings are started, the added stress of food moving through the intestine allows bacteria normally found in the intestine to invade and damage the wall of the intestinal tissues. The damage may affect only a short segment of the intestine or can progress quickly to involve a much larger portion.

The infant is unable to continue feedings and starts to appear ill if bacteria continue to spread through the wall of the intestines and sometimes into the bloodstream. He or she may also develop imbalances in the minerals in the blood.

In severe cases of NEC, a hole (perforation) may develop in the intestine, allowing bacteria to leak into the abdomen and cause life-threatening infection (peritonitis). Because the infant's body systems are immature, even with quick treatment for NEC there may be serious complications.

Other factors seem to increase the risk of developing NEC. Some experts believe that the makeup of infant formula, the rate of delivery of the formula, or the immaturity of the mucous membranes in the intestines can cause NEC. (Babies who are fed breast milk can also develop NEC, but their risk is lower.)

Another theory is that babies born through difficult deliveries with lowered oxygen levels can develop NEC. When there isn't enough oxygen, the body sends the available oxygen and blood to vital organs instead of the gastrointestinal tract, and NEC can result.

Babies with an increased number of red blood cells (polycythemia) in circulation also seem to be at higher risk for NEC. Too many red blood cells thicken the blood and hinder the transport of oxygen to the intestines.

NEC sometimes seems to occur in "epidemics," affecting several infants in the same nursery. Although this may be due to coincidence, it suggests the possibility that it could in some cases be spread from one baby to another, despite the fact that all nurseries have very strict precautions to prevent the spread of infection.

Because the exact causes of NEC are unclear, prevention is often difficult. Studies have found that breast milk (rather than formula) may reduce the incidence of NEC. Also, starting feedings after a baby is stable and slowly increasing feeding amounts have been recommended.

Symptoms:

Symptoms may include:

    Poor tolerance to feedings.

  • Feedings stay in stomach longer than expected.

  • Decreased bowel sounds.

  • Abdominal distension (bloating) and tenderness.

  • Greenish (bile-colored) vomit.

  • Redness of the abdomen.

  • Increase in stools, or lack of stools.

  • Bloody stools.

Diagnosis:

The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities. Radiographic signs of NEC include dilated bowel loops, paucity of gas, a "fixed loop" (unaltered gas-filled loop of bowel), pneumatosis intestinalis, portal venous gas, and pneumoperitoneum (extraluminal or "free air" outside the bowel within the abdomen). The pathognomic finding on plain films is pneumatosis intestinalis. More recently ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs. Diagnosis is ultimately made in 5-10% of very low-birth-weight infants (<1,500g).However, it is not known whether some underlying pathology contributes to premature birth and low birth weight.

The clinical features are divided into 3 stages:

    Stage 1 — Apnea, bradycardia, lethargy, abdominal distension and vomiting.

  • Stage 2 — Pneumatosis intestinalis and the above features.

  • Stage 3 — Low blood pressure, bradycardia, acidosis, disseminated intravascular coagulation (DIC) and anuria.

Treatment:

NEC can be extremely frightening to parents. Parents who are deprived of the experience of feeding their babies will certainly feel frustrated — their infant is so small, it just doesn't feel right to stop feedings. As important as it is to be able to hold and bond with your baby, this may not be possible while the baby is in critical condition.

Listen to and take comfort from the NICU (neonatal intensive care unit) staff — they are trained and eager to support parents of preemies as well as the preemies themselves. Remember that there's a good chance that your baby will be back on regular feedings within a short time.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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