Necrotizing enterocolitis

Necrotizing enterocolitis
SpecialtyPediatrics, gastroenterology, neonatology
SymptomsPoor feeding, bloating, decreased activity, vomiting of bile[1]
ComplicationsShort-gut syndrome, intestinal strictures, developmental delay[2]
CausesUnclear[1]
Risk factorsPreterm birth, congenital heart disease, birth asphyxia, exchange transfusion, prolonged rupture of membranes[1]
Differential diagnosisSepsis, anal fissure, infectious enterocolitis, Hirschsprung disease[2][3]
PreventionBreast milk, probiotics.[2]
TreatmentBowel rest, nasogastric tube, antibiotics, surgery[2]
PrognosisRisk of death 25%[1]

Necrotizing enterocolitis (NEC) is an intestinal disease that affects premature or very low birth weight infants.[4][1] Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and potentially death.[1][2]

The exact cause is unclear.[1] However, several risk factors have been identified. Consistently described risk factors include formula feeding, intestinal dysbiosis, low birth weight, and prematurity.[5] Maternal factors such as chorioamnionitis, cocaine abuse, intrauterine growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, pre-eclampsia, and smoking have not been consistently implicated with the development of NEC.[6][7][8][9][10] Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes.[1] The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines.[2] Diagnosis is based on symptoms and confirmed with medical imaging.[1]

Prevention includes the use of breast milk and probiotics.[2] Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics.[2] Surgery is required in those who have free air in the abdomen.[2] A number of other supportive measures may also be required.[2] Complications may include short-gut syndrome, intestinal strictures, or developmental delay.[2]

About 7% of those who are born prematurely develop NEC; however the odds of an infant developing this illness is directly related to the intensive care unit they are placed in.[4][2][11][12][13] Onset is typically in the first four weeks of life.[2] Among those affected, about 25% die.[1] The sexes are affected with equal frequency.[14] The condition was first described between 1888 and 1891.[14]

  1. ^ a b c d e f g h i j "Necrotizing Enterocolitis – Pediatrics – Merck Manuals Professional Edition". Merck Manuals Professional Edition. February 2017. Retrieved 12 December 2017.
  2. ^ a b c d e f g h i j k l m Rich BS, Dolgin SE (December 2017). "Necrotizing Enterocolitis". Pediatrics in Review. 38 (12): 552–559. doi:10.1542/pir.2017-0002. PMID 29196510. S2CID 39251333.
  3. ^ Crocetti M, Barone MA, Oski FA (2004). Oski's Essential Pediatrics. Lippincott Williams & Wilkins. p. 59. ISBN 9780781737708.
  4. ^ a b Gephart, Sheila M.; Quinn, Megan (October 2021). "A Call to Action to Fight for Equity and End Necrotizing Enterocolitis Disparities". Advances in Neonatal Care. 21 (5): 333–335. doi:10.1097/ANC.0000000000000940. ISSN 1536-0903.
  5. ^ Rose AT, Patel RM (December 2018). "A critical analysis of risk factors for necrotizing enterocolitis". Seminars in Fetal & Neonatal Medicine. 23 (6): 374–379. doi:10.1016/j.siny.2018.07.005. PMC 6269219. PMID 30115546.
  6. ^ Travers CP, Clark RH, Spitzer AR, Das A, Garite TJ, Carlo WA (March 2017). "Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study". BMJ. 356: j1039. doi:10.1136/bmj.j1039. PMC 5373674. PMID 28351838.
  7. ^ Been JV, Lievense S, Zimmermann LJ, Kramer BW, Wolfs TG (February 2013). "Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis". The Journal of Pediatrics. 162 (2): 236–42.e2. doi:10.1016/j.jpeds.2012.07.012. PMID 22920508.
  8. ^ Lu Q, Cheng S, Zhou M, Yu J (April 2017). "Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study". Pediatrics and Neonatology. 58 (2): 165–170. doi:10.1016/j.pedneo.2016.04.002. PMID 27543379.
  9. ^ Czyrko C, Del Pin CA, O'Neill JA, Peckham GJ, Ross AJ (April 1991). "Maternal cocaine abuse and necrotizing enterocolitis: outcome and survival". Journal of Pediatric Surgery. 26 (4): 414–8, discussion 419–21. doi:10.1016/0022-3468(91)90988-6. PMID 2056401.
  10. ^ Downard CD, Grant SN, Maki AC, Krupski MC, Matheson PJ, Bendon RW, et al. (July 2012). "Maternal cigarette smoking and the development of necrotizing enterocolitis". Pediatrics. 130 (1): 78–82. doi:10.1542/peds.2011-3808. PMID 22689867. S2CID 17281723.
  11. ^ Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM. Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis. J Perinatol. 2014;34(6):468-475.
  12. ^ Horbar JD, Edwards EM, Greenberg LT, et al. Variation in performance of neona-tal intensive care units in the United States. JAMA Pediatr. 2017;171(3):e164396.
  13. ^ Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical corre-lates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1991;119(4):630-638.
  14. ^ a b Panigrahi P (2006). "Necrotizing enterocolitis: a practical guide to its prevention and management". Paediatric Drugs. 8 (3): 151–165. doi:10.2165/00148581-200608030-00002. PMID 16774295. S2CID 29437889.