Necrotizing enterocolitis is an acquired disease, especially the preterm or sick newborn, which is characterized by mucous or even deeper intestinal necrosis. It is the most common gastrointestinal emergency in newborns. Symptoms and signs include food intolerance, lethargy, temperature instability, ileus, an abdominal distension, bilious vomiting, bloody stools, apnea and sometimes sepsis characters. The diagnosis is made clinically and confirmed with imaging techniques. The primary therapy is supportive and includes nasogastrales suction, intravenous fluids, parenteral nutrition, antibiotics, isolation one in case of infection and often surgical procedure.
About 85% of cases of necrotizing enterocolitis (NEC) occur in premature infants on (premature infant child). It is reason for a stay in the neonatal intensive care unit in 1-8% of cases.
Necrotizing enterocolitis is an acquired disease, especially the preterm or sick newborn, which is characterized by mucous or even deeper intestinal necrosis. It is the most common gastrointestinal emergency in newborns. Symptoms and signs include food intolerance, lethargy, temperature instability, ileus, an abdominal distension, bilious vomiting, bloody stools, apnea and sometimes sepsis characters. The diagnosis is made clinically and confirmed with imaging techniques. The primary therapy is supportive and includes nasogastrales suction, intravenous fluids, parenteral nutrition, antibiotics, isolation one in case of infection and often surgical procedure. About 85% of cases of necrotizing enterocolitis (NEC) occur in premature infants on (premature infant child). It is reason for a stay in the neonatal intensive care unit in 1-8% of cases. Risk Factors The general risk factors in addition to prematurity include Longer phase with cracked amniotic sac (Premature rupture (PROM)) with amnionitis birth asphyxia SGA infants (SGA -children) Congenital heart defects exchange transfusions (Neonatal hyperbilirubinemia: exchange transfusion) The incidence may be higher in infants who are fed with infant formulas. Three intestinal factors are usually: a preceding ischemic stroke Bacterial colonization intraluminal substrate Etiology The exact causes are not unique (ie enteral nutrition..). It is believed that an ischemic infarct so damages the intestinal walls, causing increased permeability and this tends to increased sensitivity to bacterial infections. NEC rarely occurs before enteral feedings and is less common in breastfed infants. Once the feeding starts, but there are plenty of substrate for the growth of the intraluminal bacteria which migrate through the injured bowel wall and produce hydrogen. This gas accumulates in the intestinal wall (pneumatosis intestinalis) and migrates into the portal veins. The underlying ischemic infarction could be due to a vasospasm of the mesenteric arteries, which in turn was caused by a hypoxic infarction. Such hypoxic infarction in turn triggers an evolutionary old diving reflex, which leads to a reduction of intestinal blood flow. The ischemia may also be an expression of low blood flow during exchange transfusion or during sepsis or resulting from the use hyperosmolar food. Likewise, an innate Vitium can lead to a reduction in systemic blood flow or decreased arterial O2 saturation to intestinal hypoxia / ischemia and a predisposition to NEC. NEC can heaped, occur in several cases at the same time in the newborn intensive care units. The increased incidence is often associated with certain bacteria (eg. B. Klebsiella, Escherichia coli, coagulase-negative staphylococci). Often no causative pathogenic germ is found. Complications The necrosis begins in the mucosa and can accommodate up to attack the whole intestinal wall proceed causes a perforation with subsequent peritonitis and free air in the abdomen. The perforation occurs mainly in the terminal ileum; the colon and proximal small intestine are much less affected. 33% of infants (sepsis in neonates) occurs sepsis, which can be fatal. Symptoms The infants have feeding problems and bloody or bilious stomach residues (after feeding) to the bilious vomiting, intestinal obstruction with abdominal distention or visible blood in the stool. Sepsis is expressed in lethargy, temperature instability, increased apnea seizures and metabolic acidosis. Diagnostic detection of blood in stool X-rays of the abdomen Early X-rays may be nonspecific and only show an ileus. In contrast, a fixed and dilated intestinal loop, which does not change with multiple X-ray images, to an NEC out. Characteristic radiological signs are the pneumatosis intestinalis and air in the portal vascular system. Pneumoperitoneum is a sign of a bowel perforation and an urgent indication for surgical intervention. Radiological characteristics necrotizing enterocolitis with permission of the publisher. From Langer J .: Gastroenterology and Hepatology: Pediatric Gastrointestinal problem. Edited by M. Feldman (Series Editor) and P.E. Hyman. Philadelphia, Current Medicine, 1997. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/radiologic_features_necrotizing_enterocolitis_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / images / radiologic_features_necrotizing_enterocolitis_high_de.jpg lang = en & thn = 0 ‘, title:’? Radiological properties necrotizing enterocolitis ‘description:’ u003Ca id = “v38397413 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDieses image shows a pneumatosis intestinalis (top