Pediatrics

Necrotizing enterocolitis

Synonyms

Necrotizing enterocolitis, NEK, NEC

definition

Necrotizing enterocolitis is an inflammation of the intestinal wall that occurs mainly in premature babies (birth weight <1500g), which can lead to bacterial overgrowth of the intestine and the death of individual sections (necrosis) of the intestine.

It is the most common cause of acute gastrointestinal diseases (acute abdomen) in premature babies.

root cause

The causes have not yet been fully clarified.

The causes of necrotizing enterocolitis are still not fully understood.

It is known, however, that an insufficient supply (ischemia) leads to a migration of bacteria through the intestinal wall of the end segment of the ileum (terminal ileum) and the ascending part of the large intestine (colon ascendens).
These bacteria cause inflammation of the intestinal wall, which leads to water deposits and bleeding in the intestinal wall and to the death of individual sections of the intestine (necrosis).

Ultimately, in this way, bacteria get into the abdominal cavity and can lead to inflammation of the peritoneum (peritonitis) and then to a generalized infection of the blood (sepsis) with a shock.

Possible risk factors for the development of necrotizing enterocolitis are e.g. Pulselessness (asphyxia), epidural anesthesia during childbirth (PDA), cathetherization of the umbilical cord vessels, an increased number of red blood cells (polyglobules) and shock.

Symptoms

The main symptom of necrotizing enterocolitis is found dilated, rigid loops of intestine and one bloated, painful stomach.

When examining can hardly any bowel noises to be established.
The food intake turns out to be problematic because the children cannot keep food with them and vomit have to.
Also shows the bowel movement Blood or there is no more bowel movements at all.

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Because of the spreading infection in the abdomen (Peritonitis) can Redness on the flanks be recognizable. As the infection spreads, the child's general condition deteriorates (sepsis). The children are mostly sleepy, breathing worse or not at all (Apnea) and have a very low heart rate (Bradycardia).
In addition, one often falls sallow, pale gray complexion on.

diagnosis

Since necrotizing enterocolitis is a inflammation acts, one finds increased inflammation values in the blood values, furthermore increased ones Lactate levels and Electrolyte imbalances.

Necrotizing enterocolitis can be shown well on an x-ray of the abdomen. This shows enlarged loops of the intestine as well as air bubbles in the thickened intestinal wall (pneumatosis intestinalis), which are caused by the bacteria. These gas inclusions can also occur in the intestinal veins and the portal vein (portal vein). In addition, free fluid and air can also be found in the abdomen in the X-ray image through a possible perforation of the intestine. The thickened intestinal walls and the air bubbles can also be partially detected in ultrasound (sonography).

therapy

The treatment of necrotizing enterocolitis consists of 3 important measures.

First, must be a Ingestion on the Gastrointestinal tract strictly avoided.
The child should be about for this period (about 10 days) Infusions and / or by a Nasogastric tube with the important Nutritional components, vitamins, minerals, trace elements and liquid are supplied.
When the child's condition has improved, they can slowly start building up their food.

Second, one should medical therapy With Antibiotics that target the bacteria in the intestine or in the whole body.

As a third important measure, the intestine should be through a surgery and plant one artificial anus (Anus praeterminalis) are relieved.
If the inflammation of individual sections of the intestine is already well advanced, a distance (Resection) of these intestinal sections may be necessary.

forecast

In some cases an operation is necessary.

The prospect of healing (prognosis) of necrotizing enterocolitis always depends on the severity of the disease.
The decisive factor here is the early detection of the disease and any developing infection of the entire body (sepsis). The worse the child's symptoms are and the further the necrotizing enterocolitis has progressed, the more often an operative measure is necessary. There is always the risk that the child will develop a so-called short bowel syndrome due to the extensive removal of many sections of the intestine, which can lead to diarrhea and malnutrition.

Necrotizing enterocolitis has a fatal end in about 5-10% of children with this disease.

prophylaxis

A successful preventive measure of necrotizing enterocolitis is maternal prenatal Betamethasone prophylaxis to childlike Lung maturation, if there is a threat of premature birth.
In addition, a child's diet is included Breast milk preventive, as well as one Antibiotic prophylaxis in premature babies.
Because of the resistance that develops, this approach is controversial. Current research includes the use of good strains of bacteria (Probiotics) or substances that are good Intestinal bacteria as food serve (prebiotics), and thus accelerate the development of a favorable intestinal flora.

Frequency distribution

Most often, necrotizing enterocolitis occurs in immature premature infants with a birth weight <1500g on.
The frequency of new cases (incidence) in this patient group is here about 10%, on the other hand in mature newborns less than 1%. The total rate of necrotizing enterocolitis sufferers among all live born children is approximately 1-3: 1000, with girls and boys being affected roughly equally.

Despite the great medical advances in recent years and decades, the incidence of the disease has not decreased.