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]

• Collapse

  It has a variable course ranging from feed intolerance and abdominal distension (swelling) to a sudden collapse of a baby who had previously been relatively well. [uhs.nhs.uk]

  ◦ Asphyxia and acute cardiopulmonary collapse, as they lead to low cardiac output and diminished intestinal perfusion. ◦ Enteral feeding: NEC is rare in unfed infants. [slideshare.net]

  Ultimately this can lead to respiratory failure and cardiovascular collapse requiring mechanical ventilation and vasopressors. [rarediseases.org]

  They suggest that the circulatory collapse in the first week of life may assault the gastrointestinal blood flow resulting in higher NEC incidence. [bmcpediatr.biomedcentral.com]

• Wound Infection

  PROGNOSIS.: ◦ Medical management fails in about 20–40% of patients with pneumatosis intestinalis at diagnosis; of these, 10–30% die. ◦ Early postoperative complications : Wound infection, dehiscence, and stomal problems (prolapse, necrosis). ◦ Later complications [slideshare.net]

• Malnutrition

  ◦ After massive intestinal resection, -Complications from postoperative NEC include short-bowel syndrome (malabsorption, growth failure, malnutrition), ◦ Premature infants with NEC who require surgical intervention or who have concomitant bacteremia [slideshare.net]

• Disability

  "Surgical NEC" survivors are at risk for complications including short bowel syndrome and neurodevelopmental disability. References [ edit ] ^ a b c d e f g h i j k "Necrotizing Enterocolitis – Pediatrics – Merck Manuals Professional Edition". [en.wikipedia.org]

• Pneumonia

  They show that selective ablation of Paneth cells followed by infection with Klebsiella pneumoniae causes intestinal pathology that resembles that of human NEC. [dmm.biologists.org]

  Differential Diagnosis Neonatal Pneumonia Neontal Sepsis Spontaneous intestinal perforation Infectious enterocolitis (e.g. Rotavirus ) Severe Inborn Errors of Metabolism Feeding Intolerance IX. [fpnotebook.com]

  ◦ Differential diagnosis of NEC : ◦ Specific infections (systemic or intestinal)- Pneumonia, Sepsis. ◦ Gastrointestinal obstruction, volvulus, malrotation, ◦ Isolated intestinal perforation. ◦ Severe Inherited Metabolic disorders. [slideshare.net]

  […] included prognostic studies on risk factors for NEC Boo et al. (2012) [ 21 ] Malaysia (2007) Retrospective Multivariable 3601 52% VLBW (≤1500 g) NEC II, III Maternal age, BW, surfactant, intrapartum antibiotics, indomethacin, surfactant, congenital pneumonia [bmcpediatr.biomedcentral.com]

• Severe Clinical Course

  […] resembling NEC with less systemic involvement and a less severe clinical course. [slideshare.net]

• 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]

• Failure to Thrive

  Significant long-term complications included failure-to-thrive in 23% and stricture formation in 30% of the survivors. [ncbi.nlm.nih.gov]

  […] to thrive, increased gastric residuals, abdominal distension and bloody stools. [en.wikipedia.org]

  NEC complications include inadequate nutrition with failure to thrive, electrolytes and nutrient losses, complications due to prolonged total parenteral nutrition and central venous catheters (infections, thrombus,…), intestinal surgical complications [pediatrie.be]

• Prolapse

  Occasionally the stoma may retract into the abdomen or prolapse out, which may require further surgery. When I can start milk feeds again? The length of time for recovery is very variable but it is usually 10 days before milk is reintroduced. [uhs.nhs.uk]

  ◦ Early postoperative complications : Wound infection, dehiscence, and stomal problems (prolapse, necrosis). ◦ Later complications : Intestinal strictures develop at the site of the necrotizing lesion in about 10% of surgically or medically managed [slideshare.net]

• 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]

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]

• Hyperviscosity

  Interventions that have been tried include: [ 3 ] Factors relating to feeding: Correction of hypovolaemia, hyperviscosity and allowing adequate time for homeostatic mechanisms to mature before the enteral feeding challenge is begun. [patient.info]

  ◦ Polycythymia and hyperviscosity syndrome. ◦ Exchange transfusion. ◦ Large feeding volumes and rapid advancement of enteral feedings. ◦ Enteric pathogenic organisms comprising bacterial and viral pathogens. [slideshare.net]

• Hyponatremia

  Table 6: Comparison between both groups according to the presence of hyponatremia showing significant difference in Group I between neonates at the onset of the research and after 1 week of onset ( P Click here to view [Table 7] shows Comparison between [jcnonweb.com]

  Blood studies: Thrombocytopenia COMMON TRIAD OF SIGNS Persistent Severe Refractory Metabolic Acidosis Hyponatremia 26. [slideshare.net]

• 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]

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 treatment was well-tolerated and no adverse events were observed. [o-wm.com]

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]

[…] 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]

Prognosis The mortality rate (15%-25%) for affected infants has not changed appreciably in 30 years. [humpath.com]

[…] 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]

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]

Etiology Intestinal bacteria invade immature intestinal epithelium, causing subsequent inflammation and tissue necrosis Bacteria in food produce more cytokines and injure mucosa May be due to TNF receptor 1 dependent depletion of mucus which occurs in [pathologyoutlines.com]

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]

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]

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]