Necrotising enterocolitis

  • 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

necrotising enterocolitis with mucosal oedema and pneumatosis intestinalis

  • 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

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.

Voss M,  Moore S W,  van der Merwe I,  Pieper C.  Fulminating necrotising enterocolitis.  outcome and prognosis.  Pediatr Surg Int 1998;  13:  576-586.

 

 
 

Last updated: 21 April 2009

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