What Is Necrotic Enterocolitis?

Neonatal necrotizing enterocolitis (NEC) is an acquired disease that is caused by multiple causes of intestinal mucosal damage, ischemia and hypoxia, and causes a diffuse or local necrosis of the small intestine and colon. It mainly occurs in premature babies or sick newborns. The main symptoms are abdominal distension and blood in the stool. It is characterized by intestinal mucosa and even deep intestinal necrosis. It most often occurs in the distal ileum and proximal colon. The small intestine is rarely affected. Abdominal X-ray film of the intestinal wall is characterized by cystic gas, which is a very serious neonatal digestive system disease.

Basic Information

Visiting department: Pediatrics, Gastroenterology
Multiple groups: Baby boy
Common locations: Ileum, colon

Common causes: Intestinal blood supply insufficiency, dietary factors, bacterial infections, etc.
Common symptoms: Bloating, vomiting, diarrhea, blood in the stool, weakened bowel sounds; poor response, wilting, refusing to eat; severe cases with pale or grayish gray, cold limbs, shock, etc.

Causes of neonatal necrotizing enterocolitis

Intestinal blood supply insufficiency

Such as neonatal asphyxia, hyaline membrane disease, umbilical artery intubation, erythrocytosis, hypotension, shock and so on.

2. Dietary factors

Such as hypertonic milk or hypertonic drug solution can damage the intestinal mucosa, nutrients in food are conducive to bacterial growth and carbohydrate fermentation to produce hydrogen.

3. Bacterial infection

Such as E. coli, Klebsiella, Pseudomonas aeruginosa, Salmonella, Clostridium bacillus, etc., over-proliferate, invade the intestinal mucosa and cause damage, or cause sepsis and infection, and toxic shock worsens intestinal damage.

Clinical manifestations of neonatal necrotizing enterocolitis

There are more male babies than female babies, mainly sporadic cases, no obvious seasonality, meconium after birth is normal, often onset within 2 to 3 weeks after birth, with a peak of 2 to 10 days, NEC during neonatal diarrhea It can also be a pandemic. There is no difference in gender, age and season when it is epidemic.

1. Abdominal distension and bowel sounds weaken

The patient first had delayed gastric emptying, gastric retention, and subsequent abdominal distension. Only mild abdominal distension occurred. In severe cases, the symptoms quickly worsened. The abdominal distension such as drums, bowel sounds weakened, and even disappeared. NEC premature infants had abnormal abdominal distension, abdominal distension, and bowel Weakening is an early symptom of NEC. For high-risk children, it is necessary to observe changes in abdominal distension and bowel sounds at any time.

Vomiting

Vomiting often occurs in children, and the vomit can be coffee-like or bile. Some children do not have vomiting, but coffee or bile-like gastric contents can be extracted from the stomach.

3. Diarrhea and bloody stools

Watery stools at the beginning, ranging from 5 to 6 times to 10 times a day, bloody stools after 1 to 2 days, which can be blood, jam-like or black stools. In some cases, there is no diarrhea and gross bloody stools, only stool blood. Positive.

4. Systemic symptoms

Children with NEC often have poor response, dizziness, and refusal to feed. In severe cases, they have pale or gray, cold limbs, shock, acidosis, and jaundice. Preterm infants are prone to repeated apnea, slowed heart rate, normal body temperature, or low fever. Or the temperature does not rise.

Necrotizing enterocolitis in newborns

Surrounding blood

The white blood cell count increased, the nucleus shifted to the left, and thrombocytopenia decreased.

2. Blood gas analysis and electrolyte determination

Can understand the degree of electrolyte disorders and acidosis, and guide the treatment of fluids and intravenous nutrition.

3. stool test

Appearance is dark, occult blood is positive, and there are different numbers of white blood cells and red blood cells under microscope examination. Escherichia coli, Klebsiella and Pseudomonas aeruginosa are common in stool culture.

4. Blood culture

If the cultured bacteria are consistent with fecal culture, it is meaningful for diagnosing the etiology of NEC.

5. X-ray examination of the abdomen

X-ray plain film showed that part of the intestinal wall cystic gas was of great value in the diagnosis of NEC. Follow-up inspections were needed several times to observe the dynamic changes.

Diagnosis of neonatal necrotizing enterocolitis

Children with risk factors for this disease can make a more positive diagnosis once the relevant clinical manifestations and X-ray examination changes occur.

Treatment of neonatal necrotizing enterocolitis

Mainly fasting, maintaining water-electrolyte and acid-base balance, nutrition support and symptomatic treatment. In recent years, the prognosis of this disease has been greatly improved due to the extensive application of total intravenous nutrition and enhanced supportive therapy.

Fasting

(1) Fasting time Once the diagnosis is made, fasting should be carried out immediately. The lighter is 5 to 10 days, and the severer is 10 to 15 days or longer. Gastrointestinal decompression was given when abdominal distension was obvious.

(2) Restoration of eating standards Abdominal distension disappeared, occult blood in the stool turned negative, and plain radiographs of the abdomen were normal, and the general condition improved significantly. If the child suffers from abdominal distension and vomiting after eating, fasting is required again.

(3) Feeding products When starting to eat, try to feed 5% sugar water first. If there is no vomiting and bloating after 2 to 3 times, you can change to dilute breast milk. Breast milk is the best. Hypertonic milk should be avoided.

2. Intravenous fluid replenishment and nutrition

During fasting, intravenous fluids must be given to maintain water-electrolyte, acid-base balance, and nutritional support.

(1) Fluid volume The total fluid volume per day is 100-150ml / kg.

(2) Heat card The first day of illness is guaranteed to be 209.2kJ / kg (50kcal / kg), and then gradually increased to 418.4-502.1kJ / kg (100-120kcal / kg). 40% to 50% are provided by carbohydrates, 45% to 50% are provided by fat, and 10% to 15% are provided by amino acids.

(3) Carbohydrates Intravenous infusion with glucose is generally used.

(4) Protein The main purpose of injecting amino acids is to facilitate protein synthesis under the premise of ensuring calories.

(5) Fat 10% fat emulsion injection is commonly used for infusion.

(6) Electrolyte The blood electrolyte concentration should be monitored and adjusted at any time.

(7) other trace elements and vitamins

3. Anti-infective

Ampicillin and amikacin are commonly used, and antibiotics can also be selected based on the sensitivity of the culture.

4. Symptomatic treatment

Those with severe illness and shock should be treated in time. In addition to the 2: 1 sodium-containing solution, plasma, albumin, and 10% low-molecular dextran can be used for expansion.

5. Indications for surgical treatment

Intestinal perforation, peritoneal inflammation, obvious signs and symptoms, obvious reddening of the abdominal wall, or ineffective medical treatment should be surgery.

Prevention of neonatal necrotizing enterocolitis

1. Prevent preterm birth.

2. Promote breastfeeding. Children who must be fed artificially should use a small amount of breastfeeding program to reduce the risk of NEC.

Prognosis of neonatal necrotizing enterocolitis

Neonatal necrotizing enterocolitis has a poor prognosis, and its mortality rate is high, ranging from about 10% to 30%. The incidence of intestinal stenosis is 20% to 25%.