Risk factors: perinatal insult; preemie, low apgar score
Etiology: Perinatal intestinal ischemia due to blood
shunting as a result of stress
Characterized by gas in the submucosa of the
intestine ("pneumatosis intestinalis")
May progress to perforation and gangrene.
Usually in the first few days of life
Respiratory distress (due to elevation of diaphragm)
Perforation can occur; us. in stomach
Dx: "Rigler's sign", "footbal sign"
on abd. x-ray--?
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.
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)
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)