I. Definition

  1. Acute intestinal necrosis in premature infants

II. Epidemiology

  1. Most common serious surgical condition in NICU patients
  2. Leading gastrointestinal cause of death in newborns
  3. Age of onset
    1. Mean age: 12 days of life
    2. Frequently occurs at approximately 3 days of life

III. Risk Factors

  1. Prematurity (mean gestational age 30 to 32 weeks)
    1. Represent more than 90% of NEC cases

IV. Pathophysiology

  1. Uncontrolled, exaggerated response to intestinal colonization in the premature newborn
  2. Pseudomonas aeruginosa
    1. Implicated in some cases of NEC (especially in premature infants and those with Neutropenia)
  3. Toll-like receptors (TLRs)
    1. Bacterial receptors that appear to be involved in the pathogenesis of Necrotizing Enterocolitis
    2. Research is focused on the TLRs in the prevention and treatment of NEC

V. Signs

  1. Course
    1. Either severe and rapidly progressive or insidious
  2. General
    1. Respiratory distress or apnea
    2. Bradycardia
    3. Lethargy
    4. Hypotension or decreased peripheral perfusion
  3. Gastrointestinal symptoms
    1. Abdominal distention
    2. Abdominal tenderness to palpation
    3. Increased gastric aspirates
    4. Bilious Emesis or Hematemesis
    5. Decreased or absent bowel sounds
    6. Localized abdominal mass
    7. Ascites
    8. Bloody stools

VI. Differential Diagnosis

  1. Neonatal Pneumonia
  2. Neontal Sepsis
  3. Infectious enterocolitis
  4. Severe Inborn Errors of Metabolism
  5. Feeding Intolerance

VII. Labs

  1. Complete Blood Count with Platelet Count
    1. Thrombocytopenia
  2. Basic chemistry panel (e.g. chem8)
    1. Metabolic
    2. Hyponatremia

VIII. Imaging

  1. Abdominal Xray (Anteroposterior or Cross Table lateral)
    1. Multiple dilated bowel loops that remain consistently placed on serial imaging
    2. Pneumatosis Intestinalis
      1. Gas in bowel wall in linear or with small bubbles (seen in more than 50% of NEC patients)
    3. Surveillance with serial films every 6 hours is performed in high risk premature infants
  2. Abdominal Ultrasound
    1. Thick walled loops of bowel
    2. Decreased bowel motility

IX. Management

  1. Antibiotics
  2. Emergent surgery indications
    1. Bowel infarction with progressive disease
    2. Bowel perforation
  3. Supportive care
    1. Gastrointestinal rest (NPO)
    2. Gastric decompression with Nasogastric Tube
    3. Intravenous fluid and electrolyte replacement
    4. Blood Pressure support
    5. Parenteral nutrition

X. Prognosis

  1. High morbidity and mortality that has changed little in 30 years
  2. Surgical survival approaches 50% (80% for infants <1 kg)

XI. References

  1. McAlmon in Cloherty (1991) Manual of Neonatal Care, Little Brown, Boston, p. 511-7
  2. Afrazi (2011) Pediatr Res 69:183-8

Images: Related links to external sites (from Google)

Ontology: Pneumatosis intestinalis (C1112565)

Concepts Disease or Syndrome (T047)
Dutch pneumatosis intestinalis, intestinalis; pneumatose, pneumatose; intestinalis
French Pneumatose intestinale
German Pneumatosis intestinalis
Italian Pneumatosi intestinale
Portuguese Pneumatose intestinal
Spanish Pneumatosis intestinal
Japanese 腸壁気腫症, チョウヘキキシュショウ
Czech Střevní pneumatóza
English pneumatosis intestinalis, intestinalis; pneumatosis, pneumatosis; intestinalis, Pneumatosis intestinalis
Hungarian Intestinalis pneumatosis

Ontology: Neonatal necrotizing enterocolitis (C1442826)

Concepts Disease or Syndrome (T047)
MSH D020345
SnomedCT 206525008, 51180003
English NEONATAL NECROTIZING ENTEROCOLITIS, Neonat necrotising entcolitis, Neonat necrotizing entcolitis, NNEC - Neonat necrot enterocol, NNE-Neonat necr enterocolitis, neonatal necrotizing enterocolitis, neonatal necrotizing enterocolitis (diagnosis), Necrotizing enterocolitis neonatal, Necrotising enterocolitis neonatal, Neonatal necrotizing enterocolitis, Neonatal necrotising enterocolitis, NNE - Neonatal necrotising enterocolitis, NNEC - Neonatal necrotising enterocolitis, NNE - Neonatal necrotizing enterocolitis, NNEC - Neonatal necrotizing enterocolitis, Neonatal necrotizing enterocolitis (disorder)
Italian Enterocolite necrotizzante neonatale
Dutch necrotiserende enterocolitis, neonataal, necrotiserende enterocolitis neonataal
French Entérocolite nécrosante néonatale, Entérocolite nécrosante du nouveau-né, Entérocolite nécrosante des nouveau-nés, Entéro-colite néonatale nécrosante
German nekrotisierende Enterokolitis neonatal, nekrotisierende Enterokolitis beim Neugeborenen
Japanese 新生児壊死性腸炎, シンセイジエシセイチョウエン
Czech Nekrotizující novorozenecká enterokolitida
Hungarian Újszülöttkori necrotizáló vékony- és vastagbélgyulladás, Necrotizáló újszülöttkori enterocolitis
Spanish enterocolitis necrosante neonatal (trastorno), enterocolitis necrosante neonatal, Enterocolitis necrosante neonatal
Portuguese Enterocolite necrosante neonatal