dr. Shirley L A, Sp.

A
Neonatal Necrotizing
Enterocolitis (NEC)
NEC
The most common life-threatening emergency of the
GIT in the newborn period
Characterized by various degrees of mucosal or
transmural necrosis of the intestine
The cause of NEC remains unclear but is most likely
multifactorial
Incidence : 1-5 % of infants in NICU
Both incidence & case fatality rates with BW &
gestational age
Pathology & Pathogenesis
Factors contribute to the development of a
necrotic segment of intestine :
- gas accumulation in the submucosa of the
bowel wall
(pneumatosis intestinalis)
- progression of the necrosis to perforation
- sepsis
Pathology & Pathogenesis
The triad of intestinal ischemia, oral feedings
(metabolic substrate), and pathogenic organisms
has been linked to NEC
The greatest risk factor to NEC is prematurity
E.Coli, Klebsiella, Clostridium perfringens, Stap.
Epidermidis, rotavirus has been recovered from
cultures
Clinical Manifestations
Gastrointestinal Systemic
Abdominal distention
Abdominal tenderness
Feeding intolerance
Delayed gastri emptying
Vomiting
Occult/gross blood in stool
Change in stool pattern/diarrhea
Abdominal mass
Erythema of abdominal wall
Lethargy
Apnea/respiratory distress
Temperature instability
Acidosis (metobolic and/or
respiratory)
Glucose instability
Poof perfusion/shovk
DIC
Positive results of blood cultures
Clinical Manifestations
The onset of NEC usually occurs in the first 2
week but can be as late as 3 mo of age in VLBW
infants
The first signs are abdominal distention with
gastric retentin
Obvious bloody stools are seen in 25% of
patients
Because of nonspecific signs, sepesis may be
suspected before an intestinal lesion is noted
The spectrum of illness ranges from mild disease
with only guiac-positive stools to severe illness
with bowel perforation, peritonitis, shock and
death

Diagnosis
Pneumatosis
intestinalis
linear radiolucency
parallels bowel
lumen
within bowel wall
Diagnosis
Portal vein gas is a
sign of severe disease
and
pneumoperitoneum
indicates a perforation
Diagnosis
Blue : subdiafragmatic
free
air, double wall
sign
Green : triagle sign
Red : falciform
ligament