Presentation
PURPOSE: A retrospective, 12-year review of neonatal necrotizing enterocolitis was undertaken at a county hospital, with emphasis on presentation signs and symptoms. [ncbi.nlm.nih.gov]
Entire Body System
- Poor Growth
CONCLUSION: This study suggests that increased serum levels of pro-inflammatory cytokines may play a role in the poor growth and neurodevelopment associated with this high-risk population. [ncbi.nlm.nih.gov]
Despite treatment, about 15% of babies who develop NEC die and some babies that survive suffer from numerous complications such as short bowel syndrome, poor growth, and long-term neurodevelopmental impairments [4]. [rarediseases.org]
Gastrointestinal
- Intestinal Perforation
Peritoneal drainage is more successful in patients with isolated intestinal perforation. 36. [slideshare.net]
Necrosis begins in the mucosa and may progress to involve the full thickness of the intestinal wall, causing intestinal perforation with subsequent peritonitis and often free intra-abdominal air. [merckmanuals.com]
Differential Diagnosis Neonatal Pneumonia Neontal Sepsis Spontaneous intestinal perforation Infectious enterocolitis (e.g. Rotavirus ) Severe Inborn Errors of Metabolism Feeding Intolerance IX. [fpnotebook.com]
Complications may include: Peritonitis Sepsis Intestinal perforation Intestinal stricture Liver problems from prolonged inability to tolerate enteral feeds and need for parenteral (IV) nutrition Short bowel syndrome if a large amount of intestine is lost [medlineplus.gov]
[…] obstruction of newborn P76.0 Meconium plug syndrome P76.1 Transitory ileus of newborn P76.2 Intestinal obstruction due to inspissated milk P76.8 Other specified intestinal obstruction of newborn P76.9 Intestinal obstruction of newborn, unspecified P77 [icd10data.com]
- Intestinal Disease
Although the role of clostridial toxins in the pathogenesis of NEC is unknown, clostridial toxins are well established as the causes of two other intestinal diseases (antibiotic-associated pseudomembranous colitis and pig-bel). [ncbi.nlm.nih.gov]
It is a devastating intestinal disease that primarily affects preemies and medically fragile infants. [necsociety.org]
You are here Steven J McElroy MD Peer Review Status: Internally Peered Review Definition Neonatal necrotizing enterocolitis (NEC) is an inflammatory intestinal disease of newborn infants. [uichildrens.org]
Necrotizing enterocolitis (nek-roh-TIE-zing en-ter-oh-coh-LIE-tis), or NEC, is the most common and serious intestinal disease among premature babies. It happens when tissue in the small or large intestine is injured or inflamed. [kidshealth.org]
The exact mechanism of this disease, while not fully understood, is believed to be multifactorial and related to a premature intestine, abnormal gut microbial colonization, and intestinal inflammation. [rarediseases.org]
Psychiatrical
- Suggestibility
Reparative tissue changes such as epithelial regeneration, granulation tissue formation, and fibrosis, found in two thirds of cases, suggested ongoing tissue injury of at least several days' duration. [ncbi.nlm.nih.gov]
Recent randomized trials suggest that the choice of operation does not influence patient outcome. [humpath.com]
Workup
The supervising physician and nurse practitioner ordered continued observations and additional workups for sepsis if symptoms occurred. The female infant's abdomen was continuously documented due to increase of her abdominal girth. [ahcmedia.com]
X-Ray
- Colonic Stricture
Predisposing factors prematurity enteral feeding infection Complications colonic stricture ileocolic fistula ( 19304467 ) Intestinal fistula is a rare complication in necrotizing enterocolitis (NEC) and is typically associated with a colonic stricture [humpath.com]
Microbiology
- Bordetella Pertussis
pertussis and other bordetella sp infections; herpes simplex; toxoplasmosis; pneumocystis and other less common fungal infections; and healthcare-associated infections in the nursery Keep up with the most relevant topics in fetal/neonatal infectious [books.google.de]
Colonoscopy
- Colitis
Although the role of clostridial toxins in the pathogenesis of NEC is unknown, clostridial toxins are well established as the causes of two other intestinal diseases (antibiotic-associated pseudomembranous colitis and pig-bel). [ncbi.nlm.nih.gov]
[…] and colitis NOS ( A09 ) neonatal diarrhea (noninfective) ( P78.3 ) psychogenic diarrhea ( F45.8 ) necrotizing K55.30 ICD-10-CM Diagnosis Code K55.30 Necrotizing enterocolitis, unspecified 2017 - New Code 2018 2019 Billable/Specific Code Applicable To [icd10data.com]
[…] enterocolitis is based on Symptoms The presence of severe neutropenia Results of abdominal CT and blood and stool cultures and toxin tests Neutropenic enterocolitis must be distinguished from C. difficile –induced diarrhea, graft-vs-host disease, and colitis [merckmanuals.com]
[…] or ecchymotic colitis (1,5,9). [hawaii.edu]
Pseudomembranous colitis. Stress ulcer. Meconium ileus. Metabolic or respiratory acidosis. Apnoea or prematurity. Bacteraemia. Candidiasis. Coarctation of the aorta. Enteroviral infection. Gastro-oesophageal reflux. Hirschsprung's disease. [patient.info]
Treatment
These data support the hypothesis that the incidence of NEC is significantly reduced after prenatal steroid treatment. [ncbi.nlm.nih.gov]
ABSTRACT Objective: To determine the risk factors in neonatal necrotizing enterocolitis (NEC) and provide options for the prevention and treatment of NEC. [mona.uwi.edu]
The pathogenesis remains incompletely understood and there is no specific treatment. Efforts are ongoing to understand aspects of intestinal immaturity which contribute to susceptibility to this disease. [eurekaselect.com]
The treatment was well-tolerated and no adverse events were observed. [o-wm.com]
Prognosis
Full-term neonates had a better prognosis in our series. Presentation of symptoms more than 20 days after birth did not change outcome. CONCLUSION: Our results reflect the experience of a community-based hospital. [ncbi.nlm.nih.gov]
Prognosis The mortality rate (15%-25%) for affected infants has not changed appreciably in 30 years. [humpath.com]
[…] admitted to our hospital between January 2004 and April 2012, were reviewed and analyzed, including clinical characteristics, maternal factors during perinatal period, newborn factors, feeding history, concomitant diseases, antibiotic treatment and prognosis [mona.uwi.edu]
[…] transfusion, prolonged rupture of membranes [1] Differential diagnosis Sepsis, anal fissure, infectious enterocolitis, Hirschsprung disease [2] [3] Prevention Breast milk, probiotics. [2] Treatment Bowel rest, nasogastric tube, antibiotics, surgery [2] Prognosis [en.wikipedia.org]
Prognosis Research Strategy (PROGRESS) 2: prognostic factor research. PLoS Med. 2013;10(2):e1001380. [bmcpediatr.biomedcentral.com]
Etiology
Thrombosis of the aorta, with occlusion of one or more of its major abdominal branches following umbilical arterial catheterization, should be considered as a potential etiologic factor in certain cases of NNE. [ncbi.nlm.nih.gov]
Etiology The etiology is controversial, several factors have been suggested as being important: intestinal ischemia enteral feeding abnormal intestinal flora, bacterial overgrowth intestinal mucosal immaturity NEC in premature infants The average age [atlases.muni.cz]
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. [radiopaedia.org]
Necrotizing enterocolitis (NEC) is intestinal necrosis of uncertain etiology; it occurs mainly in preterm or sick neonates after enteral feedings have begun. [merckmanuals.com]
Epidemiology
Epidemiologic studies have identified enteral feedings as a risk factor for necrotizing enterocolitis (NEC). [ncbi.nlm.nih.gov]
Clinical signs and some epidemiological studies are consistent with clostridia involvement in NEC. [clinicaltrials.gov]
Epidemiology of necrotising enterocolitis. Acta Paediatrica. 1994;83(396):2-7. Newell SJ. Gastrointestinal disorders: Necrotising enterocolitis. In: Rennie JM, Roberton NRC, eds. [ijpediatrics.com]
[…] feedings Infants fed breast milk developed 6-10 times less NEC than infants fed formula alone and 3 times less than infants fed breast milk + formula Treatment Antibiotics Choice of antibiotics will depend upon previous therapy, presence of invasive lines, epidemiology [uichildrens.org]
Pathophysiology
This article discusses the definition of necrotizing enterocolitis, presents current knowledge regarding its basic pathophysiology, and identifies common and rare sequelae of this oftentimes devastating disease of premature infants. [ncbi.nlm.nih.gov]
Necrotizing enterocolitis: recent scientific advances in pathophysiology and prevention. Semin Perinatol 32, 70-82 (2008). McElroy, S.J., Underwood, M.A. & Sherman, M.P. [uichildrens.org]
Prevention
Strikingly, the aerosolized administration of a novel carbohydrate TLR4 inhibitor prevented CXCL5 upregulation and blocked NEC-induced lung injury in mice. [ncbi.nlm.nih.gov]
Necrotizing enterocolitis: recent scientific advances in pathophysiology and prevention. Semin Perinatol 32, 70-82 (2008). McElroy, S.J., Underwood, M.A. & Sherman, M.P. [uichildrens.org]
Authors' conclusions: Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice. [cochrane.org]