NECROTIZING ENTEROCOLITIS


  • Risk factors: perinatal insult; preemie, low apgar score
  • Etiology: Perinatal intestinal ischemia due to blood shunting as a result of stress
  • Pathophysiology
  • Characterized by gas in the submucosa of the intestine ("pneumatosis intestinalis")
  • May progress to perforation and gangrene.
  • Presentation
  • Usually in the first few days of life
  • Abdominal distension
  • Respiratory distress (due to elevation of diaphragm)
  • Cyanosis
  • Perforation can occur; us. in stomach
  • Dx: "Rigler's sign", "footbal sign" on abd. x-ray--?
  • Prevention
  • Probiotics for prevention of necrotizing enterocolitis:
  • In a Cochrane review of nine trials involving 1,425 infants born at < 37wks or with birth weight < 2.5kg randomized to enteral probiotics vs. placebo, enteral probiotic recipients had sig. lower incidence of stage II or III NEC (RR 0.32) and sig. lower mortality (RR 0.43) (AlFaleh K and Bassler D.  1/23/2008 http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005496/frame.html)
  • In a meta-analysis of data from 11 trials involving 2,1776 preterm infants with birth weights < 1.5kg randomized to probiotics vs. placebo, the probiotic recipients had sig. lower incidence of NEC (RR 0.35) and all-cause mortality (RR 0.42) (Pediat. 125:921, 2010-JW)
  • Treatment:
  • Standard treatment consists of resection of affected portion of GI tract
  • Alternative approach with peritoneal drainage followed by late resection if not resolved was associated with no sig. diff. in incidence of death, dependence on TPN, or duration of hospitalization, at 90d f/u in a randomized trial in 117 premature infants with NEC and perforation. (NEJM 354:2225, 2006--JW)