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Updated: Feb 19 2019

Necrotizing Enterocolitis


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  • Snapshot
    • A 26-day-old boy presents to the pediatrician due to increased irritability and episodes of vomiting after feeding. He also reports that the patient appears lethargic. Obstetric history is significant for a spontaneous vaginal delivery at 29 weeks gestation and weight of 1005 grams at birth. He was born to a 32-year-old mother. On physical examination, there is abdominal distension. Laboratory testing is significant for heme-positive stool and thrombocytopenia. An abdominal radiograph is shown.
  • Introduction
    • Clinical definition
      • acute neonatal intestinal necrosis
    • Epidemiology
      • incidence
        • 0.1% of all live births
      • demographics
        • more common in males
      • risk factors
        • infants born ≤ 35 weeks gestation especially with
          • a birth weight < 1000 g
        • early-onset neonatal sepsis
        • mechanical ventilation
        • 5-minute APGAR < 7
    • Pathogenesis
      • although the pathogenesis is unclear, it is believed to be due to an exaggerated inflammatory response to some sort of insult (e.g., enteral feeds in a premature infant) that injures
        • immature intestinal epithelial cells
    • Associated conditions
      • prematurity
    • Prognosis
      • 15-30% overall mortality and increased mortality with
        • prematurity
        • low birth weight
  • Presentation
    • Symptoms
      • feeding intolerance (e.g., emesis)
      • lethargy
      • apnea
      • dyspnea
        • may require ventilatory support
    • Physical exam
      • abdominal distension
      • blood in stool
  • Imaging
    • Radiography
      • view
        • abdominal in the supine position
      • indication
        • abdominal radiagraphy is used to confirm the diagnosis of suspected necrotizing enterocolitis
      • findings
        • findings suggestive of necrotizing enterocolitis include
          • pneumatosis intestinalis (hallmark of the disease)
          • hepatobiliary gas
          • pneumoperitoneum
  • Studies
    • Labs
      • complete blood count (CBC)
        • thrombocytopenia is often found and can suggest
          • worsening disease progression if they are declining
      • serum chemistry
      • blood culture
    • Diagnostic criteria
      • the diagnosis is based on abdominal radiographic findings (e.g., pneumatosis intestinalis) and characteristic clinical findings such as
        • abdominal distention
        • rectal bleeding (the bleeding can be occult or grossly present)
  • Differential
    • Spontaneous intestinal perforation
    • Infectious enteritis
  • Treatment
    • Medical
      • intravenous broad-spectrum antibiotics
        • indication
          • administered after appropriate samples are obtained for culture
        • modalities
          • an example of medications used for necrotizing include
            • ampicillin, gentamicin, and metronidazole
    • Operative
      • abdominal surgery
        • indication
          • an absolute indication for abdominal surgey is intestinal perforation
        • technique
          • exploratory laparotomy with bowel resection
          • primary peritoneal drainage
  • Complications
    • Bowel perforation
    • Disseminated intravascular coagulation
    • Infectious complications (e.g., peritonitis)
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