- Affects 0.5 to 1 per 1000 live births
- Aetiology unknown but bacterial infection and hypoxia appear
important
- 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
Clinical features
- Usually occurs in the first week of life
- Child is lethargic and apathetic with vomiting and increasing
abdominal distension
- 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
surgical intervention
- Portal venous gas is a poor prognostic sign
Treatment
- Initial treatment involves vigorous resuscitation and medical
management
- 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
anastomosis
Picture provided by Mr Man Harjoi. Army Hospital, New
Delhi, India
Prognosis
- 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
Bibliography
Buonomo C. The radiology
of necrotising enterocolitis.
Radiol Clin North Am 1999;
37: 1187-1198.
Chandler J C, Holme A.
Necrotising enterocolitis in infants with very low birth weight.
Semin Pediatr Surg 2000;
9: 63-72.
Hall N, Pierro A. Necrotising enterocolitis. Hosp
Med 2004; 65: 220-225.
Lin P W, Stoll B J. Necrotising enterocolitis.
Lancet 2006; 368: 1271-1283.
Neu J, Walker W A. Necrotising enterocolitis. N
Engl J Med 2011; 364: 255-264.
Voss M, Moore S W,
van der Merwe I,
Pieper C. Fulminating
necrotising enterocolitis.
outcome and prognosis.
Pediatr Surg Int 1998;
13: 576-586. |