NECROTIZING ENTEROCOLITIS
N |
ecrotising enterocolitis is the most common
gastro-intestinal disorder and is a surgical emergency in neonates. Mortality
rates exceedingly more than 50% in premature babies or those whose weight is
less than 1500 grams.
NEC (Necrotising Enterocolitis) occurs in three groups
of babies –
1. Term
babies with risk factors
2. Preterm
babies (immaturity of the gut)
3. Babies
with IUGR (Intra-Uterine-Growth-Retardation)
4. Any
other food given other than breast milk for the baby
5. Ischaemia
to the gut
Basically, what happens in NEC is, due to ischaemia, there
occurs a decrease in blood supply to the gut, this leads to necrosis and
increase in air accumulation inside the gut. This causes excessive filling of
the gut with the air leading to bloating of the gut. This condition is called
as Pneumatosis intestinalis. This leads to distention of the abdomen and
bleeding with the gut bacteria to migrate to peritoneum and cause infection
there.
If this air leaks out it leads to –
1. Pneumoperitoneum
2. Pneumatosis
portalis (air in portal system)
3. Peritonitis
(bacterial infection of the peritoneum)
Images showing Pneumatosis intestinalis (air bubbles seen)
1. Apnoea
2. Lethargy
3. Shock
(in advanced stages)
4. Decreased
peripheral perfusion
5. Cardiovascular
collapse
6. Increased
abdominal girth
7. Visible
intestinal loops
8. Distention
of abdomen with decreased abdominal sounds
9. Palpable
abdominal mass
10. Acidosis
11. Hyponatraemia
12. Thrombocytopaenia
Differential diagnosis –
1. Hirschprung
disease
2. Meningitis
3. UTI
4. Malrotation
5. Volvulus
6. Septicaemia
Bell’s staging for NEC –
1. Stage
I – bleeding, abdominal distention, decreased bowel sounds.
Ia – occult bleeding in
stools
Ib – Gross bleeding in
stools
2. Stage
II – Definite NEC, where air enters the bowel.
IIa – pneumatosis intestinalis
IIb – pneumatosis portalis
Triad of NEC seen – Acidosis +
hyponatraemia + thrombocytopaenia
3. Stage
III – Advanced stage of NEC
IIIa – peritonitis, ascites
IIIb – pneumoperitoneum
Treatment –
1. Upto
stage IIIa – keep the child NBM, i.e. nil by mouth and start broad spectrum
antibiotics.
2. Stage
IIIb – If baby is unstable – peritoneal drainage, if baby is stable and can be
taken to OT – Laparotomy.
Prevention –
1. Antenatal
steroids
2. Minimal
Enteral Nutrition.
Comments
Post a Comment