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  • Necrotizing Enterocolitis: Department of Childhealth, School of Medicine, University of North Sumatera Medan

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    BRI KU
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    Necrotizing enterocolitis (NEC) is a disease that affects the intestines of premature infants. It occurs most often in infants born weighing less than 1,500 grams or before 32 weeks gestation. The cause involves an interaction between intestinal ischemia, poor intestinal integrity, microbial infection, and enteral nutrition. Symptoms include lethargy, vomiting, abdominal distension and bloody diarrhea. Diagnosis is confirmed with x-rays showing intestinal abnormalities. Treatment involves stopping feeding, providing intravenous fluids and antibiotics. In severe cases, surgery may be required to address intestinal perforation. Risk can be reduced through exclusive breastfeeding, minimal enteral feeds, and use of probiotics.

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    Necrotizing enterocolitis (NEC) is a disease that affects the intestines of premature infants. It occurs most often in infants born weighing less than 1,500 grams or before 32 weeks gestation. The cause involves an interaction between intestinal ischemia, poor intestinal integrity, microbial infection, and enteral nutrition. Symptoms include lethargy, vomiting, abdominal distension and bloody diarrhea. Diagnosis is confirmed with x-rays showing intestinal abnormalities. Treatment involves stopping feeding, providing intravenous fluids and antibiotics. In severe cases, surgery may be required to address intestinal perforation. Risk can be reduced through exclusive breastfeeding, minimal enteral feeds, and use of probiotics.

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    8 visualizzazioni17 pagine

    Necrotizing Enterocolitis: Department of Childhealth, School of Medicine, University of North Sumatera Medan

    Caricato da

    BRI KU
    Necrotizing enterocolitis (NEC) is a disease that affects the intestines of premature infants. It occurs most often in infants born weighing less than 1,500 grams or before 32 weeks gestation. The cause involves an interaction between intestinal ischemia, poor intestinal integrity, microbial infection, and enteral nutrition. Symptoms include lethargy, vomiting, abdominal distension and bloody diarrhea. Diagnosis is confirmed with x-rays showing intestinal abnormalities. Treatment involves stopping feeding, providing intravenous fluids and antibiotics. In severe cases, surgery may be required to address intestinal perforation. Risk can be reduced through exclusive breastfeeding, minimal enteral feeds, and use of probiotics.

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    di 17

    NECROTIZING

    ENTEROCOLITIS
    Atan Baas Sinuhaji

    Department of Childhealth,School of
    Medicine,University of North Sumatera
    Medan

    Necrotising Enterocolitis (NEC)


    Affects 0.5 to 1 per 1000 live births
    Incidence 3-10% in infants < 1500 g
    Incidence increase with decreasing
    birthweigh and gestational age
    Usually affects terminal ileum and
    colon to a variable extent
    NEC rarely occus before the initiation
    of enteral
    feeding

    NECROTIZING
    ENTEROCOLITIS
    An Acute Intestinal Necrosis Syndrome Resulting From
    Complex Interaction :
    = Gut Ischemia
    = Poor Mucosal Integrity
    = Microbial Infection
    = Enteral Nutrition

    MUCOSAL INJURY

    INTESTINAL PERFORATION

    Immaturity

    Ischaemia
    Milk feeds

    Loss of barrier function


    Mucosal disruption

    Bacterial translocation
    Macromolecular absorption

    Mucosal damage

    Toxins

    Bacterial overgrowth
    Viruses

    NEC

    ors
    Bacteria

    Mucus

    enterocyt
    Goblet cell
    nucleus

    ENTERAL FEEDING
    1.PROVIDES SUBSTRATE FOR
    PROLIFERATION OF
    ENTERAL
    PATHOGENS
    2.HYPEROSMOLAR FORMULA
    MUCOSAL
    DAMAGE
    3.LACK OF IMMUNOPROTECTIVE FACTORS
    4.AGGRESSIVE ENTERAL FEEDING
    5.BREASTFEEDING
    LOWERS THE RISK
    OF NEC

    Necrotising Enterocolitis (NEC)


    Clinical features
    Usually occurs in the first two weeks of life
    Child is lethargic and apathetic with vomiting
    and increasing
    abdominal distension
    Bloody diarrhoea is a late feature
    Progression may be rapid from to mild to
    severe after 72 hours
    Abdominal examination may show peritonitis
    or a mass

    Abdominal x-ray may show


    Distended bowel with mucosa

    edema
    Intramural gas ( = pneumatosis
    intestinalis )
    Portal venous gas or free
    intraperitoneal gas

    Abdominal x-ray

    AA

    Abdominal x-ray

    Treatment
    A. Medical

    No definitive

    treatment

    B. Surgical

    1. Perforation
    2.Fixed dilated loop on serial x-ray
    3.Abdominal wall cellulitis
    4.Progressive deterioration despite
    maximal medical
    support

    Medical
    1.Preventing futher injury

    a. Cessation of feeding
    b. Decompression
    c. IntraVenous Fluid Drip ( IVFD )
    2.Supportive
    a. Respiration status
    b. Coagulation profile
    c. Electrolyte and Acid base balance
    d. Antibiotics

    PREVENTION
    1. EXCLUSIVELY BREAST-FED
    2. MINIMAL ENTERAL FEEDS FOLLOWED BY
    JUDICIOUS VOLUME ADVANCEMENT
    3. PROBIOTIC

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