- Affects 0.5 to 1 per 1000 live births
- Aetiology unknown but bacterial infection and hypoxia appear
- Occurs in premature or low birth weight infants
- Associated with:
- Premature rupture of membranes
- Prolonged labour
- Hypoxia and respiratory distress
- Also well recognised following umbilical artery catheterisation
- Usually affects terminal ileum and colon to a variable extent
- Characterised by mucosal necrosis with progression to intestinal
infarction and perforation
- Usually occurs in the first week of life
- Child is lethargic and apathetic with vomiting and increasing
- Bloody diarrhoea is a late feature
- Abdominal examination may show peritonitis or a mass
- Abdominal x-ray may show:
- Distended bowel with mucosal oedema
- Intramural gas (= pneumatosis intestinalis)
- Portal venous gas or free intraperitoneal gas
- Extent of pneumatosis is not proportional to severity of illness
- The presence of pneumatosis per se is not an indication for
- Portal venous gas is a poor prognostic sign
- Initial treatment involves vigorous resuscitation and medical
- Nasogastric intubation, fluids and antibiotics are important
- Parenteral nutrition should be considered
- Indications for surgery include:
- Increasing peritonitis
- Failure of stabilisation with medical treatment
- Development of an abdominal mass
- Persistent loop or free gas on an abdominal x-ray
- Surgical treatment will involve resection with possible primary
Picture provided by Mr Man Harjoi. Army Hospital, New
- Overall the prognosis is poor
- Mortality of those undergoing medical treatment is about 20%
- Mortality of those coming to surgery is about 30%
- Amongst survivors about 30% develop ischaemic colonic strictures
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