Back التهاب معوي قولوني ناخر Arabic Enterocolitis necrosant Catalan Nekrotisierende Enterokolitis German Enterocolitis necrosante Spanish انتروکولیت نکروزان FA Entérocolite nécrosante French Enterocolite necrosante GL דלקת מעי נמקית HE Նեկրոզացնող էնտերոկոլիտ HY Enterocolite necrotizzante Italian

Necrotizing enterocolitis

Necrotizing enterocolitis
SpecialtyPediatrics, gastroenterology, neonatology
SymptomsPoor feeding, bloating, decreased activity, vomiting of bile[1]
ComplicationsShort-gut syndrome, intestinal strictures, developmental delay[2]
CausesUnclear[1]
Risk factorsPreterm birth, congenital heart disease, birth asphyxia, exchange transfusion, prolonged rupture of membranes[1]
Differential diagnosisSepsis, anal fissure, infectious enterocolitis, Hirschsprung disease[2][3]
PreventionBreast milk, probiotics.[2]
TreatmentBowel rest, nasogastric tube, antibiotics, surgery[2]
PrognosisRisk of death 25%[1]

Necrotizing enterocolitis (NEC) is an intestinal disease that affects premature or very low birth weight infants.[4][1] Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and potentially death.[1][2]

The exact cause is unclear.[1] However, several risk factors have been identified. Consistently described risk factors include formula feeding, intestinal dysbiosis, low birth weight, and prematurity.[5] Maternal factors such as chorioamnionitis, cocaine abuse, intrauterine growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, pre-eclampsia, and smoking have not been consistently implicated with the development of NEC.[6][7][8][9][10] Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes.[1] The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines.[2] Diagnosis is based on symptoms and confirmed with medical imaging.[1]

Prevention includes the use of breast milk and probiotics.[2] Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics.[2] Surgery is required in those who have free air in the abdomen.[2] A number of other supportive measures may also be required.[2] Complications may include short-gut syndrome, intestinal strictures, or developmental delay.[2]

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.[4][2][11][12][13] Onset is typically in the first four weeks of life.[2] Among those affected, about 25% die.[1] The sexes are affected with equal frequency.[14] The condition was first described between 1888 and 1891.[14]

  1. ^ a b c d e f g h i j "Necrotizing Enterocolitis – Pediatrics – Merck Manuals Professional Edition". Merck Manuals Professional Edition. February 2017. Retrieved 12 December 2017.
  2. ^ a b c d e f g h i j k l m Rich BS, Dolgin SE (December 2017). "Necrotizing Enterocolitis". Pediatrics in Review. 38 (12): 552–559. doi:10.1542/pir.2017-0002. PMID 29196510. S2CID 39251333.
  3. ^ Crocetti M, Barone MA, Oski FA (2004). Oski's Essential Pediatrics. Lippincott Williams & Wilkins. p. 59. ISBN 9780781737708.
  4. ^ a b Gephart, Sheila M.; Quinn, Megan (October 2021). "A Call to Action to Fight for Equity and End Necrotizing Enterocolitis Disparities". Advances in Neonatal Care. 21 (5): 333–335. doi:10.1097/ANC.0000000000000940. ISSN 1536-0903.
  5. ^ Rose AT, Patel RM (December 2018). "A critical analysis of risk factors for necrotizing enterocolitis". Seminars in Fetal & Neonatal Medicine. 23 (6): 374–379. doi:10.1016/j.siny.2018.07.005. PMC 6269219. PMID 30115546.
  6. ^ Travers CP, Clark RH, Spitzer AR, Das A, Garite TJ, Carlo WA (March 2017). "Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study". BMJ. 356: j1039. doi:10.1136/bmj.j1039. PMC 5373674. PMID 28351838.
  7. ^ Been JV, Lievense S, Zimmermann LJ, Kramer BW, Wolfs TG (February 2013). "Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis". The Journal of Pediatrics. 162 (2): 236–42.e2. doi:10.1016/j.jpeds.2012.07.012. PMID 22920508.
  8. ^ Lu Q, Cheng S, Zhou M, Yu J (April 2017). "Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study". Pediatrics and Neonatology. 58 (2): 165–170. doi:10.1016/j.pedneo.2016.04.002. PMID 27543379.
  9. ^ Czyrko C, Del Pin CA, O'Neill JA, Peckham GJ, Ross AJ (April 1991). "Maternal cocaine abuse and necrotizing enterocolitis: outcome and survival". Journal of Pediatric Surgery. 26 (4): 414–8, discussion 419–21. doi:10.1016/0022-3468(91)90988-6. PMID 2056401.
  10. ^ Downard CD, Grant SN, Maki AC, Krupski MC, Matheson PJ, Bendon RW, et al. (July 2012). "Maternal cigarette smoking and the development of necrotizing enterocolitis". Pediatrics. 130 (1): 78–82. doi:10.1542/peds.2011-3808. PMID 22689867. S2CID 17281723.
  11. ^ Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM. Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis. J Perinatol. 2014;34(6):468-475.
  12. ^ Horbar JD, Edwards EM, Greenberg LT, et al. Variation in performance of neona-tal intensive care units in the United States. JAMA Pediatr. 2017;171(3):e164396.
  13. ^ Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical corre-lates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1991;119(4):630-638.
  14. ^ a b Panigrahi P (2006). "Necrotizing enterocolitis: a practical guide to its prevention and management". Paediatric Drugs. 8 (3): 151–165. doi:10.2165/00148581-200608030-00002. PMID 16774295. S2CID 29437889.

Necrotizing enterocolitis

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