ENTEROCOLITIS NECROTIZANTE NEONATAL PDF

Necrotizing enterocolitis NEC is the most common gastrointestinal condition in premature neonates. It is characterized by inflammation, ischemia, and permeability of the neonatal bowel wall to bacteria. It is potentially life-threatening with significant associated morbidity 1. NEC is usually idiopathic and multi-factorial. A combination of ischemic and infective etiology with added contributive factors such as immature immunity have been proposed 1.

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Necrotizing enterocolitis NEC is the most common gastrointestinal condition in premature neonates. It is characterized by inflammation, ischemia, and permeability of the neonatal bowel wall to bacteria. It is potentially life-threatening with significant associated morbidity 1. NEC is usually idiopathic and multi-factorial. A combination of ischemic and infective etiology with added contributive factors such as immature immunity have been proposed 1.

Although a partially infective etiology has been hypothesized, no causative organism has been isolated. Translocation of intestinal flora through immature mucosa has been postulated 5. Inflammation starts from the mucosal surface and progresses to hemorrhagic and coagulative necrosis.

There is ensuing loss of mucosal integrity, transmural necrosis, and perforation. Although NEC can affect any part of the large or small bowel, the most common location is the terminal ileum. The right colon including cecum is occasionally involved. Involvement of the stomach is less common. Supine abdominal x-rays are the mainstay of diagnosis. Findings include:. NEC can be managed both medically and surgically and appropriate patient selection is essential in optimizing outcome. A clinical staging system has been developed see necrotizing enterocolitis staging , with stage I and II receiving medical therapy and stage III undergoing surgery 8.

Medical management consists of supportive measures and cessation of oral feeding, along with broad-spectrum antibiotics and gastric aspiration 7. Surgery is usually reserved for patients with evidence of perforation and entails resection of clearly necrotic bowel and the creation of a proximal enterostomy Other relative indications for surgery include portal venous gas , a fixed dilated loop on serial x-rays and abdominal wall erythema 7.

Re-anastomosis is usually delayed until the infant has completely recovered. In the correct clinical scenario, the presence of gas within bowel wall has a little differential. Conditions worth keeping in mind include 8 :. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form.

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Necrotizing enterocolitis

Necrotizing enterocolitis NEC is a serious illness in newborns. It happens when tissue in the large intestine colon gets inflamed. Any newborn can get NEC. This is especially true for babies who weigh less than 3 pounds, 4 ounces 1, grams.

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Necrotizing Enterocolitis

Necrotizing enterocolitis is among the most common and devastating diseases in neonates. It has also been one of the most difficult to eradicate 1 and thus has become a priority for research. The excessive inflammatory process initiated in the highly immunoreactive intestine in necrotizing enterocolitis extends the effects of the disease systemically, affecting distant organs such as the brain and placing affected infants at substantially increased risk for neurodevelopmental delays. In one study, 12 infants with necrotizing enterocolitis were hospitalized 60 days longer than unaffected preterm infants if surgery was required and more than 20 days longer if surgery was not necessary. The need for bowel resection is one of the most common severe complications of necrotizing enterocolitis and is the major cause of the short-bowel syndrome in pediatric patients.

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