Necrotizing enterocolitis
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Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects premature or very low birth weight infants.[4][1] Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and even death.[1][2]
Necrotizing enterocolitis | |
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Specialty | Pediatrics, gastroenterology, neonatology |
Symptoms | Poor feeding, bloating, decreased activity, vomiting of bile[1] |
Complications | Short-gut syndrome, intestinal strictures, developmental delay[2] |
Causes | Unclear[1] |
Risk factors | Preterm birth, congenital heart disease, birth asphyxia, exchange transfusion, prolonged rupture of membranes[1] |
Differential diagnosis | Sepsis, anal fissure, infectious enterocolitis, Hirschsprung disease[2][3] |
Prevention | Breast milk, probiotics.[2] |
Treatment | Bowel rest, nasogastric tube, antibiotics, surgery[2] |
Prognosis | Risk of death 25%[1] |
The exact cause is unclear.[1] However, several risk factors have been identified. Consistently described risk factors include formula feeding, intestinal dysbiosis, low birth weight, and prematurity.[5] Maternal factors such as chorioamnionitis, cocaine abuse, intrauterine growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, pre-eclampsia, and smoking have not been consistently implicated with the development of NEC.[6][7][8][9][10] Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes.[1] The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines.[2] Diagnosis is based on symptoms and confirmed with medical imaging.[1]
Prevention includes the use of breast milk and probiotics.[2] Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics.[2] Surgery is required in those who have free air in the abdomen.[2] A number of other supportive measures may also be required.[2] Complications may include short-gut syndrome, intestinal strictures, or developmental delay.[2]
About 7% of those who are born prematurely develop NEC; however the odds of an infant developing this illness is directly related to the intensive care unit they are placed in.[11][12][13][4][2] Onset is typically in the first four weeks of life.[2] Among those affected, about 25% die.[1] The sexes are affected with equal frequency.[14] The condition was first described between 1888 and 1891.[14]