·Definition: A serious bacterial infection in the intestine, primarily of sick or premature newborn infants. It can cause the death (necrosis) of intestinal tissue and progress to blood poisoning (septicemia).
Causes of Necrotizing Enterocolitis:
1. The infection usually develops after the bowel wall has already been weakened or damaged by a lack of oxygen, predisposing it to bacterial invasion.
2. It almost always occurs in the first month of life.
3. Conditions that make newborns susceptible:
- Primary - Prematurity
- Respiratory distress syndrome (RDS)
- Congenital heart problems
- Episodes of apnea (cessation of breathing)
Symptoms of Necrotizing Enterocolitis:
1. Intolerance to formula
2. Distended and tender abdomen
3. Vomiting
4. Blood (visible or not) in the stool
5. Need for mechanical support of the infant’s breathing
Diagnosis:
1. X-rays of the bowel
2. Blood tests (These confirm the diagnosis.)
Treatment:
1. Tube feedings into the gastrointestinal tract are discontinued.
2. Intravenous fluids are given for several weeks while the bowel heals.
3. Some infants are:
- Placed on a ventilator to help them breathe
- Given platelet transfusions
- Given antibiotics
4. Surgery (when the condition does not improve with medical therapy or there are signs that the condition is worsening.)
- Some infants may have portions of the bowel removed
- Sometimes necessary to create a substitute bowel (by making an opening into the abdomen through the skin, from which waste products are discharged temporarily), but this procedure is not done often.
5. Post-operative complications:
- Wound infection
- Lack of healing
- Persistent sepsis and bowel necrosis
- Serious internal bleeding (Disseminated intravascular coagulation)
Prognosis:
1. Necrotizing enterocolitis is the most common cause of death in newborns undergoing surgery. The average mortality is 30-40%, and even higher in severe cases.
2. About 10-35% of all survivors will eventually develop a stricture, or narrowing, of the intestine (that occurs with healing).
3. Infants may also be more susceptible to future bacterial infections in the gastrointestinal tract.
4. Infants with severe cases may also suffer neurological impairment.
Prevention:
1. In very small or sick premature infants, the risk for this may be diminished by beginning parenteral nutrition (tube feedings into the veins) and delaying enteral feedings (tube feedings into the gastrointestinal tract) for several days to weeks.
2. Some people have suggested that breast milk provides substances that may be protective, but this does not give evidence that it reduces the risk of infection.
3. Sometimes necrotizing enterocolitis occurs in clusters, or outbreaks, in neonatal units. Persons caring for these infants must employ strict measures to prevent spreading the infection.
