NECROTIZING
ENTEROCOLITIS:
- An acute intestinal necrosis
resulting from ischemia and /or
reperfusion injury.
- It is less common in breast fed
infants.
- Commonly seen in VLBW infants.
- Mortality reaches 22%.
•
•
factors:
Risk
Prematurity.
Perinatal Asphyxia.
Polycythemia.
Umbilical catheterization.
Hypothermia.
Empirical antibiotic use(> 5days).
.
CLINICAL PRESENTATION:
• -Bloody diarrhea ( 25%).
-Tense ,distended ,tender abdomen with
edema and inflammation of abdominal wall
(Peau d orange appearance).
• - Ascites is a late sign.
• -The baby might pass into septic shock.
Advanced cases will have a
triad of :
1. Thrombocytopenia
.
2. Persistent
metabolic
acidosis
.
3. Refractory
hyponatremia
.
Diagnosis:
•
1.X-ray abdomen&Abdominal ultrasound :
.Intramural gas (pneumatosis intestinalis).
.Gas in the portal tree.
.Gas under the diaphragm which follows
intestinal perforation.
• 2. C.B.C. :Thrombocytopenia with low
or increased WBC count.
3. Blood culture.
• 4. Hyperkalemia.
MANAGEMENT:
• 1. Stop oral feeding.
• 2. NG tube drainage.
• 3. Correct electrolytes , acidosis and
hypothermia.
• 4. Antibiotics:
Ampicillin+Gentamicin+Metronidazole
•
.
• 5. Remove umbilical catheters.
• 6. Assisted ventilation.
• 7. Treat hypotension by i.v. fluid, plasma,
blood,dopamine.
• 8. T.P.N.
COMPLICATIONS:
- Perforation.
- Acquired short bowel syndrome
surgery).
- DIC.
- - Sepsis and shock.
- Abscess formation.