Necrotizing Enterocolitis

Other conditions that result in mucosal injury also have been linked to NEC:

-hypoxia

-polycythemia

-hyperosmolar feedings

-gastrointestinal infection

(bacterial or viral)

-severe cardiopulmonary

disease

How is necrotizing enterocolitis diagnosed?

The doctor will ask about your baby’s symptoms and past health. The doctor may do tests, such as:

An X-ray of your newborn’s belly.

A test to check for blood in your baby’s stool (fecal occult blood test).

Tests to check for bacteria in the stool, blood, urine, or spinal fluid.

Treatment

DIAGNOSIS

How is necrotizing enterocolitis diagnosed?

• Abdominal x-ray (looking for free air)
• Stool for occult blood
• Elevated white blood cell count in a CBC
• Thrombocytopenia (low platelet count)
• ABG (acidosis)

Stool culture, BCx, U/A and LP to check for bacteria in the stool, blood, urine, or spinal fluid.

Depend on how severe the problem is.

May include:

A distended, tender, red, or shiny abdomen.

Constipation/Diarrhea.

Dark, black, or bloody stools.

Temperature instability.

Chills and fever.

Tachycardia and tachypnea.

Not wanting to eat.

Vomiting and feeding intolerance.

Being less active or lethargic.

Necrotizing Enterocolitis

You might be an NICU nurse if... *Finding poop in a diaper makes you cheer because you are obsessed with NEC and suspicious all your babies have it.

Intestinal Mucosal Immaturity

Necrotizing Enterocolitis (NEC)

*Infection & Inflammation of the intestine

*Occurs when the lining of the intestinal wall dies & the tissue falls off

*Exact cause remains unknown - thought to be that a decrease in blood flow to the bowel, ischemia and/or reperfusion injury exacerbated by the activation of pro-inflammatory intracellular cascades play a significant role. Possible infectious etiology and translocation of intestinal flora all play a role in the etiology of the disease.

Inflammation

*Bacterial colonization of the gut

*May occur when the immune & digestive systems do not form completely (immature intestinal barrier and dysfunction) ex. when baby is born prematurely, when there are problems during pregnancy or delivery or in a baby who is already sick

*Less common in breast milk fed babies than

high concentration formula fed babies

Premature InfantsIntestinal mucosal immaturity

• Decrease risk of NEC with increased gestational age
• Gastric acid and pepsin production are decreased during the first month of life
• Pancreatic exocrine insufficiency with low levels of eneterokinase
• Mucous secretion is decreased
• Impaired gut motility and poorly coordinated peristaltic activity
• Immunoglobulin A IgA is deficient in the intestinal tract of prems not fed breast milk

Signs & Symptoms

Depend on how severe the problem is:

A distended, tender, red, or shiny abdomen.

Palpable bowel loops.

Increasing abdominal girth.

Constipation/Diarrhea.

Dark, black, or bloody stools.

Temperature instability.

Chills and fever.

Tachycardia and tachypnea.

Not wanting to eat.

Vomiting and feeding intolerance.

Less active or lethargic.

TREATMENT

In an infant suspected of having NEC, feedings are stopped and gas is relieved from the bowel by inserting an NG. IVF TPN & basic replaces formula or breast milk. Antibiotic therapy is started. The infant's condition is monitored with abdominal x-rays, blood tests, and blood gases.

Surgery will be needed if there is a hole in the intestines or peritonitis (inflammation of the abdominal wall). The dead bowel tissue is removed and a colostomy or ileostomy is performed. The bowel is then reconnected several weeks or months later when the infection and inflammation have healed.

Early aggressive treatment helps improve outcomes!