Necrotizing enterocolitis
| Necrotizing enterocolitis | |
|---|---|
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| Radiograph of an infant with necrotizing enterocolitis | |
| Classification and external resources | |
| Specialty | pediatrics, gastroenterology |
| ICD-10 | P77 |
| ICD-9-CM | 777.5 |
| DiseasesDB | 31774 |
| MedlinePlus | 001148 |
| eMedicine | ped/2981 radio/469 |
| MeSH | D020345 |
Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death). It occurs postnatally (i.e. it is not seen in stillborn infants) and is the second most common cause of morbidity in premature infants, causing 355 deaths per year in the United States in 2013, down from 484 in 2009. Rates per 100,000 live births were almost three times higher for black populations than for white populations.
The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth (i.e. the earlier a baby is born, the later signs of NEC are typically seen). Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.
The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities, most commonly radiography. Specific radiographic signs of NEC are associated with specific Bell's stages of the disease:
Bell's stage 1/Suspected disease:
Bell's stage 2/Definite disease:
Bell's stage 3/Advanced disease:
More recently ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs, specifically in cases that involve a paucity of bowel gas, a gasless abdomen, or a sentinel loop. Diagnosis is ultimately made in 5–10% of very low-birth-weight infants (<1,500g).
Treatment consists primarily of supportive care including providing bowel rest by stopping enteral feeds, gastric decompression with intermittent suction, fluid repletion to correct electrolyte abnormalities and third-space losses, support for blood pressure, parenteral nutrition, and prompt antibiotic therapy. Monitoring is clinical, although serial supine and left lateral decubitus abdominal x-rays should be performed every six hours. Where the disease is not halted through medical treatment alone, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is generally required, although abdominal drains may be placed in very unstable infants as a temporizing measure. Surgery may require a colostomy, which may be able to be reversed at a later time. Some children may suffer from short bowel syndrome if extensive portions of the bowel had to be removed.
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