Necrotizing enterocolitis
Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects premature or very low birth weight infants. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, bowel death, multiorgan failure, and even death.
| Necrotizing enterocolitis | |
|---|---|
| Specialty | Pediatrics, gastroenterology, neonatology |
| Symptoms | Poor feeding, bloating, decreased activity, vomiting of bile |
| Complications | Short-gut syndrome, intestinal strictures, developmental delay |
| Causes | Unclear |
| Risk factors | Preterm birth, congenital heart disease, birth asphyxia, exchange transfusion, prolonged rupture of membranes |
| Differential diagnosis | Sepsis, anal fissure, infectious enterocolitis, Hirschsprung disease |
| Prevention | Breast milk, probiotics. |
| Treatment | Bowel rest, nasogastric tube, antibiotics, surgery |
| Prognosis | Risk of death 25% |
The exact cause is unclear. However, several risk factors have been identified. Consistently described risk factors include formula feeding, intestinal dysbiosis, low birth weight, and prematurity. Maternal factors such as chorioamnionitis, cocaine abuse, in utero growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, preeclampsia, and smoking have not been consistently implicated with the development of NEC. Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.
Prevention includes the use of breast milk and probiotics. Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics. Surgery is required in those who have free air in the abdomen. A number of other supportive measures may also be required. Complications may include short-gut syndrome, intestinal strictures, or developmental delay.
About 7% of those who are born prematurely develop NEC; however the odds of an infant developing this illness is directly related to the intensive care unit they are placed in. Onset is typically in the first four weeks of life. Among those affected, about 25% die. The sexes are affected with equal frequency. The condition was first described between 1888 and 1891.