Necrotizing Enterocolitis
Necrotizing enterocolitis is injury to the inner surface of the intestine.
Necrotizing enterocolitis usually occurs in premature newborns. The cause is not understood. Diminished blood flow to the intestine in a sick premature newborn may result in injury to the inner layers of the intestine, allowing bacteria that normally exist within the intestine to invade the damaged intestinal wall. If the injury progresses through the entire thickness of the bowel wall and the intestinal wall perforates, intestinal contents leak into the abdominal cavity and cause peritonitis. Necrotizing enterocolitis can also lead to infection of the blood (sepsis). In the most severe cases, necrotizing enterocolitis can be fatal.
Newborns with necrotizing enterocolitis may develop swelling of the abdomen. They may vomit bile-stained intestinal fluid, and blood may be visible in the stools. These newborns soon appear very sick and lethargic and have low body temperature and repeated pauses of breathing (apnea spells). The diagnosis of necrotizing enterocolitis is confirmed by abdominal x-rays. Blood samples are taken for blood cultures to identify the bacteria responsible for the infection.
Prevention, Treatment, and Prognosis
Feeding the premature newborn breast milk rather than formula appears to provide some protection. In tiny or sick premature newborns, the risk may also be reduced by delaying feedings for several days and then increasing the amount of feedings slowly. Feedings are stopped if necrotizing enterocolitis is suspected. A suction tube is passed into the newborn's stomach to remove pressure from swallowed air and formula, thereby decompressing the intestine. Intravenous fluids are given to maintain hydration, and antibiotics are begun after blood cultures have been obtained.
About 70% of newborns with necrotizing enterocolitis do not need surgery. If the intestine perforates, then surgery is needed. Surgery may also be needed if the condition progressively worsens despite treatment.
In the tiniest and sickest newborns, "peritoneal drains" are placed into the abdominal cavity on each side of the lower abdomen. The drains allow stool and peritoneal fluid to drain from the abdominal cavity and, along with antibiotics, may allow symptoms to improve. The condition of many newborns treated with drains stabilizes, so that an operation can be performed more safely at a later time. In some cases, the newborns recover completely without needing additional surgery.
Larger infants need surgery in which portions of the bowel are removed and the ends of the healthy bowel are brought out to the skin surface to create a temporary opening for the excretion of bodily wastes (ostomy).
Intensive medical treatment and surgery when needed have improved the prognosis for newborns with necrotizing enterocolitis. More than two thirds of such newborns survive.
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