Premature infant with feeding problems

Premature infant with feeding problems.

.

.

.

.

DX.Necrotizing Enterocolitis

General Considerations

Most common gastrointestinal medical and/or surgical emergency occurring in neonates

Etiology

Remains unknown

Ischemia and/or reperfusion injury may play a role

Cluster cases and outbreaks in nurseries imply an infectious etiology

A single causative organism has not been found

Translocation of intestinal flora across compromised mucosa may play a role

Incidence and age at onset

More common in premature infants

But can also be seen in term babies

Inversely related to birth weight and gestational age

Term infants develop NEC earlier after birth than preemies

Average age of onset occurs within first week of life

Affected term neonates are usually systemically ill with other conditions such as birth asphyxia, respiratory distress or congenital heart disease

Premature babies are at risk for several weeks after birth

Babies who are breastfed have a lower incidence of NEC than formula-fed babies

Clinical findings

Initial symptoms may be subtle and can include the following

Feeding intolerance

Delayed gastric emptying

Abdominal distention and/or tenderness

Ileus/decreased bowel sounds

Imaging findings

Acute disease most commonly affects the terminal ileum

Plain film of the abdomen remains method in which disease is diagnosed most often

Findings include

Dilated loops of bowel

Thickened bowel walls

Fixed and dilated loop that persists is especially worrisome

Absence of bowel gas

Pneumatosis intestinalis

Pathognomonic of NEC in newborn

Linear radiolucency parallels bowel lumen within bowel wall

Represents air that has entered from the lumen

Abdominal free air

Ominous

Usually requires emergency surgical intervention

May require a left lateral decubitus view to be seen

Portal venous gas

Originally thought to be ominous but is now considered less so

Appears as linear branching areas of decreased density over periphery of the liver

Represents air in portal venous system

Ascites

Late finding

Develops after perforation when peritonitis is present

Complications

Occur in about 75% of all patients survive

Of those who survive, 50% develop a long-term complication

Two most common complications are intestinal stricture and short-gut syndrome

Intestinal strictures

Can develop in infants with or without a preceding perforation

Incidence is 25-33%

Strictures most commonly involve the left side of the colon

Diagnosed with barium enema

Short-gut syndrome

Malabsorption syndrome resulting from removal of excessive or critical portions of small

Neonatal gut will grow this growth may take as long as 2 years to occur

Mortality

Mortality rate ranges from 10-44% in infants weighing less than 1500 g