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Neonatal Necrotizing Enterocolitis


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]
  • The age of presentation was 5.2 /- 4.0 days and majority (81%) presented during first week of life, most severe cases presenting earlier than the mild cases.[ncbi.nlm.nih.gov]
  • Abstract The aim of the present study was to investigate the association of neonatal necrotizing enterocolitis (NEC) with myeloid differentiation-(MD-2) and GM2 activator protein (GM2A) genetic polymorphisms.[ncbi.nlm.nih.gov]
  • A 10-year-old girl presented with abdominal distension and vomiting due to a jejunojejunal bowel fistula, forming a blind loop.[ncbi.nlm.nih.gov]
  • 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]
Severe Clinical Course
  • . ( avery ) Spontaneous intestinal perforation is a clinical syndrome of undetermined cause resembling NEC with less systemic involvement and a less severe clinical course. It may represent a variant of classic NEC. Delay gastic emptying 1.[slideshare.net]
Intestinal Perforation
  • Gastrointestinal obstruction, volvulus, malrotation, Isolated intestinal perforation. Severe Inherited Metabolic disorders.[slideshare.net]
  • Complications include intestinal perforation (most often in the terminal ileum) and peritonitis; sepsis occurs in 33%, and death may occur.[merckmanuals.com]
  • Attridge JT, Clark R, Walker MW, Gordon PV: New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006;26:93-99.[karger.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]
  • Conclusion A 6-day-old, premature male neonate with a dehisced abdomen and additional complications (consequences of his intestinal perforation) that resulted in an ileostomy was provided NPWT as part of treatment.[o-wm.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]
  • 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]
  • It is a devastating intestinal disease that primarily affects preemies and medically fragile infants.[necsociety.org]
  • Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria? J Perinatol 2007;27:661-71. 18. Pammi M, Brocklehurst P. Granulocyte transfusions for neonates with confirmed or suspected sepsis and neutropenia.[jcnonweb.com]
  • 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]
Rectal Bleeding
  • An exploratory midline laparotomy was performed on day 3 of life owing to rectal bleeding and abdominal distension that did not respond to gastric decompression, bowel rest, and intravenous antibiotics.[o-wm.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]
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]
Clostridium Perfringens
  • Indeed, Clostridium butyricum, Clostridium perfringens, and Clostridium paraputrificum have been isolated from the blood, feces, and peritoneal fluids of preterm neonates suffering from NEC.[clinicaltrials.gov]
  • Various bacterial and viral agents, including Escherichia coli, Klebsiella, Clostridium perfringens, Staphylococcus epidermidis, and rotavirus, have been recovered from cultures. However, in most situations, no pathogen is identified.[slideshare.net]
  • Clostridial necrotizing enteritis is necrosis of the jejunum and ileum caused by Clostridium perfringens. Clostridial necrotizing enteritis is a mild to severe clostridial infection, which can be fatal if not treated promptly.[merckmanuals.com]
  • Occurring either sporadically or in epidemics, it is thought to be due to food contaminated with different strains of Clostridium perfringens (type A for most sporadic cases and probably type C for larger outbreaks). [ 20 ] The disease course usually[patient.info]
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]
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]
  • ., galactosemia with Escherichia coli sepsis) Feeding intolerance Severe allergic colitis Idiopathic focal intestinal perforation can occur spontaneously or after the early use of postnatal steroids and indomethacin. 31.[slideshare.net]
  • […] 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]
  • ., volvulus, pyloric stenosis, ileal atresia, Hirschsprung's disease), neonatal appendicitis, spontaneous bowel perforation, and pseudomembranous colitis or ecchymotic colitis (1,5,9). Aggressive treatment is indicated in all suspected cases of NEC.[hawaii.edu]

Treatment

  • These data support the hypothesis that the incidence of NEC is significantly reduced after prenatal steroid treatment.[ncbi.nlm.nih.gov]
  • Sixty-four patients were treated medically and 18 had operative treatment. Mortality of the surgically treated group was 44 percent.[ncbi.nlm.nih.gov]
  • Understanding the regulation of these molecular interactions may provide new approaches for prevention or treatment of this dreaded condition.[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]
  • Further investigation of the role of clostridia in the pathogenesis of NEC and of the use of oral, nonabsorbable antibiotics in the treatment of NEC is needed.[ncbi.nlm.nih.gov]

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]
  • […] 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]
  • It can lead to severe morbidity and even mortality, so early detection of NEC would give us good chance for early prevention and treatment with better prognosis. [1], [2], [3], [4] Free radicals play a significant role in the pathogenesis of neonatal[jcnonweb.com]

Etiology

  • Abstract Neonatal necrotizing enterocolitis (NEC) is an increasingly frequent condition encountered in premature infants for which the etiology is not well understood.[ncbi.nlm.nih.gov]
  • 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]
  • ETIOLOGY: Etiology of NEC is unclear; May be multifactorial. Prematurity is the single greatest risk factor. Infants exposed to cocaine have a 2.5 times increased risk of developing NEC.[slideshare.net]
  • 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]

Epidemiology

  • Epidemiologic studies have identified enteral feedings as a risk factor for necrotizing enterocolitis (NEC).[ncbi.nlm.nih.gov]
  • OBJECTIVE: To study epidemiology including various risk factors incorporated in neonatal necrotizing enterocolitis in Kashmir.[ncbi.nlm.nih.gov]
  • Clinical signs and some epidemiological studies are consistent with clostridia involvement in NEC.[clinicaltrials.gov]
  • […] 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]
  • Pita-Fernández is a researcher in the Clinical Epidemiology and Biostatistics Research Group; and Dr. Caramés Bouzán is a pediatric surgeon, Department of Pediatric Surgery, University Hospital A, Coruña, Spain.[o-wm.com]
Sex distribution
Age distribution

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]
  • Overall, coagulation necrosis was more severe than any other finding in most infants, indicating the importance of ischemia in the pathophysiology of necrotizing enterocolitis.[ncbi.nlm.nih.gov]
  • TNF-alpha are elevated in patients with necrotizing enterocolitis and that suppressed platelet activating factor degradation contributes to the increased platelet activating factor levels; platelet activating factor and TNF-alpha may contribute to the pathophysiology[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]
  • Here we address some of the clinical and laboratory manifestations, pathophysiology, and new research areas pertaining to NEC. 2013 S.[karger.com]

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]
  • Understanding the regulation of these molecular interactions may provide new approaches for prevention or treatment of this dreaded condition.[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]
  • In addition, Epo treatment protected intestinal barrier function and prevented loss of ZO-1 at the TJs in vivo. These effects were associated with elevated Akt phosphorylation in the intestine.[ncbi.nlm.nih.gov]

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