Necrotizing enterocolitis (NEC)

Abstract

Necrotizing enterocolitis occurs in about ten percent of babies in the newborn intensive care unit. It is most common among very preterm infants weighing less than 1500g, but it may occur in term babies with specific risk factors. It is a severe necrotic lesion that often affects the distal part of ileum and proximal colon. It most commonly occurs within the first two weeks of life, particularly after the commencement of oral feeding. This condition is the end result of two major pathologies, particularly intestinal ischaemia and infection. Hypoxia, hypotension, sepsis, umbilical catheterization and heart diseases are risk factors for ischaemia. Bacterial colonization of the gut usually follows milk feeding, particularly with hyperosmolar artificial milk. Epidemics have been associated with Klebsiella species, Escherichia coli, Staphylococcus albus, Clostridium species and viruses like enteroviruses and rotavirus. The earliest clinical feature is poor feeding tolerance. Subsequent features include bilous vomiting, passage of mucoid bloody stools, abdominal distension and abdominal tenderness. Features of systemic toxicity may also occur in severe cases. A frequent radiological feature is pneumatosis intestinalis. Bowel perforation and disseminated intravascular coagulopathy are common complications. Overall mortality is consistently less than or about 30% in most cases, despite improved medical and surgical care. © 2012 by Nova Science Publishers, Inc. All rights reserved.