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Necrotizing enterocolitis.

Nigel Hall·Agostino Pierro
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Abstract

Necrotizing enterocolitis is the principal cause of surgical referral in preterm neonates and the most common gastrointestinal emergency among infants. Its pathophysiology is unclear and it carries high levels of mortality and morbidity. This article provides an overview of necrotizing enterocolitis including risk factors, preventative strategies and medical and surgical management.

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Enterocolitis, NecrotizingHumansInfantInfant, NewbornIntestinal ObstructionNutrition DisordersPrognosisRisk FactorsJournal ArticleResearch Support, Non-U.S. Gov'tReview

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Nigel Hall, Agostino Pierro. 2004. Necrotizing enterocolitis.. https://doi.org/10.12968/hosp.2004.65.4.12735

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PubMed2005

Severe thrombocytopenia predicts outcome in neonates with necrotizing enterocolitis.

OBJECTIVE: Necrotizing enterocolitis (NEC) is a common and serious gastrointestinal disorder that predominately affects premature infants. Few prognostic indices are available to guide physicians through the expected course of the disease. We hypothesized that the degree and timing of onset of severe thrombocytopenia (platelet count <100,000/mm(3)) would be a predictor of adverse outcome and an indication for surgical intervention in infants with NEC. STUDY DESIGN: The clinical presentation and outcome of all infants with Bell stage II or III NEC treated at Texas Children's Hospital between 1997 and 2001 were retrospectively reviewed. Patients were stratified into two groups based on the presence (Group1) or absence (Group 2) of severe thrombocytopenia (platelet count <100,000/mm(3)) within 3 days of a diagnosis of NEC. Differences between groups were compared using logistic regression to estimate adjusted odds ratios. RESULTS: A total of 91 infants met inclusion criteria (average birth weight 1288+/-135 g; average gestational age 29.0+/-3.0 weeks). Compared to infants in Group 2, infants in Group 1 were more premature (28.0+/-4.1 vs 30.0+/-4.2 weeks; p=0.02), more likely to have received postnatal steroids (42.5% vs 20.4%; p=0.02), and more likely to require laparotomy for gangrenous bowel (adjusted OR 16.33; p<0. 001). The presence of severe thrombocytopenia was also a predictor of mortality (adjusted OR 6.39; p=0.002) and NEC-related gastrointestinal complications including cholestatic liver disease and short bowel syndrome (adjusted OR 5.47; p=0.006). CONCLUSION: Severe thrombocytopenia within the first 3 days after a diagnosis of NEC suggests a higher likelihood of bowel gangrene, morbidity, and mortality. Prospective studies of infants with early and severe thrombocytopenia may help determine the optimal timing of laparotomy in infants with NEC.

Enterocolitis, Necrotizing↗
PubMed2004

Laparoscopy assists surgical decision making in infants with necrotizing enterocolitis.

BACKGROUND: Lack of specific indications for surgical intervention is not uncommon in critically ill infants with necrotizing enterocolitis (NEC). The authors hypothesized that knowledge of the extent of intestinal disease would assist in deciding the operative treatment of choice. The authors report that initial experience with laparoscopy in infants with NEC. METHODS: Prospective evaluation was done of 11 infants with a clinical diagnosis of NEC who were deteriorating despite maximal medical therapy. All underwent laparoscopy on the intensive care unit (ICU). RESULTS: Median gestational age at birth was 29 weeks (range, 24 to 34) and median weight at the time of laparoscopy was 1.2 kg (range, 0.6 to 2.9). Laparoscopy was tolerated well in all cases. NEC was excluded because of the normal intestinal appearance in 2 infants and confirmed in the remaining 9. Urgent laparotomy was avoided in 8 infants, in one of whom a laparoscopically guided ileostomy was performed. In 5 infants, a Penrose drain was inserted at laparoscopy; 3 of these did not require further surgery, and the remaining 2 underwent delayed laparotomy. Three infants, all with intestinal gangrene, died. CONCLUSIONS: Laparoscopy performed in the ICU can provide information regarding intestinal viability which can guide further surgical management. It is feasible and tolerated well even in critically ill neonates less than 1,000 g.

Enterocolitis, Necrotizing↗