Necrotizing Enterocolitis

• • Most frequent surgical condition in a neonate

  • Associated with multiple comorbidities resulting in mucosal injury of the intestine

  • Most commonly affecting terminal ileum and right colon

Epidemiology

• • 1-3/1000 births and in 30/1000 of low-birth-weight babies

Symptoms and Signs

• • Abdominal distention

  • Feeding intolerance

  • Bilious emesis

  • Occult or gross blood in stool

  • Abdominal tenderness

  • Abdominal wall edema, crepitus, or discoloration (suggest perforation)

  • Temperature instability

  • Apnea

  • Bradycardia

Laboratory Findings

• • Hypoxemia

  • Acidosis

  • Thrombocytopenia

Imaging Findings

• • Abdominal x-ray: Shows pneumatosis intestinalis from 20% to 98% of time, thickened loops of bowel, ascites, and portal venous gas; possible pneumoperitoneum

Rule Out

• • Perforation

• • History and physical exam

  • ABG measurements

  • CBC

  • Electrolytes

  • Abdominal x-ray

Surgery

• • Exploratory laparotomy if patient decompensates or does not improve after 24-72 hours of medical management, pneumoperitoneum, portal venous gas, abdominal wall erythema, or crepitus; resection of necrotic bowel, proximal enterostomy, and distal mucous fistula

Medications

• • 90% can be managed medically with NG decompression, bowel rest, broad-spectrum antibiotics, and correction of other comorbid conditions

Complications

• • 20-40% complication rate including leak, stomal necrosis, fistula formation, and stricture

Prognosis

• • Mortality rate, 20-40%

References