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PubMed2000

Anaesthetic management of liver haemorrhage during laparotomy in a premature infant with necrotizing enterocolitis.

The case of a 680 g premature baby who developed massive spontaneous liver haemorrhage during laparotomy for necrotizing enterocolitis is reported. The infant survived due to rapid and massive fluid administration, including transfusion of large volumes of blood and blood products, in combination with high dose inotropic support and the surgical use of packing with thrombostatic sponges. Good venous access, including two central venous lines, turned out to be very useful.

Anesthesia, General↗
PubMed2005

Necrotizing enterocolitis after antipsychotic treatment involving clozapine and review of severe digestive complications -- a case report.

A case of necrotizing enterocolitis in a 19-year old man treated for schizophrenic disorder, induced by a drug association involving clozapine and requiring surgical treatment, is presented. To our knowledge only few reports have described the occurrence of this complication with atypical antipsychotics. Evidence for linking this complication to clozapine was reinforced by the absence of any viral or bacterial infection. The authors present a review of similar cases, stress the potential hazards induced by such drug combinations and discuss supposed mechanisms of this enterocolitis.

Adult↗
PubMed2005

Up-regulation of macrophage migration inhibitory factor in infants with acute neonatal necrotizing enterocolitis.

AIMS: To investigate the role of macrophage migration inhibitory factor (MIF) and its downstream cytokine cascade in necrotizing enterocolitis (NEC). METHODS AND RESULTS: The expression of MIF mRNA and protein in NEC guts was assayed by in situ hybridization and immunohistochemistry, respectively. Concentrations of MIF, interleukin (IL)-6 and IL-8 in the serum and in the supernatant of macrophage cultures were examined by ELISA. Increased expression of MIF mRNA and protein was observed in the NEC guts, mainly in the infiltrating macrophages in the mucosa and submucosal layers. Up-regulation of MIF was associated with the accumulation of macrophages and T cells. In addition, serum levels of MIF, IL-6 and IL-8 in NEC patients during the acute stage of the disease were significantly increased. The expression of MIF decreased both locally and systemically after the disease was resolved. MIF was also found to increase the secretion of IL-6 and IL-8 by macrophages isolated from healthy individuals in vitro in NEC. CONCLUSIONS: MIF acts by stimulating macrophage production of IL-6 and IL-8. This further aggravates the inflammatory process by increasing the infiltration of neutrophils and activating inflammatory cells. The results of this study suggest that MIF plays an important role in the pathogenesis of NEC and may serve as a target for therapeutic intervention in NEC.

Acute Disease↗
PubMed2005

C-reactive protein in the diagnosis, management, and prognosis of neonatal necrotizing enterocolitis.

OBJECTIVE: In this prospective, observational study, we determined whether serum C-reactive protein (CRP) correlated with necrotizing enterocolitis (NEC) stages II and III. We hypothesized that serial CRP measurement if used as an adjunct to abdominal radiographs would improve the identification of infants with NEC. METHODS: Serum CRP level was measured every 12 hours for 3 measurements and, when abnormal, once daily. When clinical signs persisted and the initial abdominal radiographs were abnormal, follow-up radiographs were obtained. RESULTS: Of 241 infants who were evaluated for gastrointestinal signs, 11 had ileus or benign pneumatosis intestinalis with persistently normal CRP; gastrointestinal manifestations resolved within 48 hours, antibiotics were discontinued in <48 hours, and feedings were restarted early without complications. Fifty-five infants had NEC stages II and III; all had abnormal CRP regardless of their blood culture results. In infants with stage II NEC, CRP returned to normal at a mean of 9 days except in those who developed complications such as stricture or abscess formation. CONCLUSIONS: In infants with suspected NEC, normal serial CRP values would favor aborted antibiotic therapy and early resumption of feedings. CRP becomes abnormal in both stage II and stage III NEC. In infants with NEC, persistently elevated CRP after initiation of appropriate medical management suggests associated complications, which may require surgical intervention.

Biomarkers↗
PubMed2005

Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis.

OBJECTIVE: Candida and coagulase-negative staphylococci are emerging pathogens associated with focal intestinal perforation (FIP) and necrotizing enterocolitis (NEC) in neonates. The objective of this study was to determine whether there are significant differences in the predominant pathogens in culture-positive cases of peritonitis associated with FIP compared with NEC in neonates. METHODS: A retrospective cross-sectional study was conducted of neonates with peritoneal culture-positive peritonitis associated with FIP or NEC over a 12-year study period (1989-2000). Cases with peritonitis were identified from a microbiology database. NEC was defined by radiologic evidence of pneumatosis intestinalis or portal venous gas or by pathology reports or surgical operative notes describing large areas of transmural bowel necrosis. FIP was defined as a <1-cm intestinal perforation surrounded by otherwise normal tissue in the absence of NEC. RESULTS: Thirty-six cases of FIP were compared with 80 cases of NEC. Birth weight and gestational age were significantly lower in infants with FIP compared with NEC. Age at intestinal perforation and case fatality rates were similar between FIP and NEC. There were striking differences in the distribution of predominant pathogens associated with peritonitis in NEC and FIP cases. Enterobacteriaceae were present in 60 (75%) of 80 NEC cases compared with 9 (25%) of 36 FIP cases. In contrast, Candida species were found in 16 (44%) of 36 FIP cases compared with 12 (15%) of 80 NEC cases, and coagulase-negative staphylococci were present in 18 (50%) of 36 FIP cases versus 11 (14%) of 80 NEC cases. There were no significant differences between FIP and NEC cases for the presence of Enterococcus species (28% vs 23%) or anaerobes (3% vs 6%). Stratified analysis for birth weight <1200 g found similar significant differences in the predominant pathogens for FIP (n = 29) and NEC (n = 38). Results from peritoneal fluid cultures resulted in changes in antimicrobial therapy in 46 (40%) of 116 cases. CONCLUSIONS: Candida species and coagulase-negative staphylococci were the predominant pathogens in FIP peritonitis in contrast to Enterobacteriaceae in NEC peritonitis. A peritoneal fluid culture should be obtained in all neonates with intestinal perforation, regardless of cause, because it may help to direct the choice of the most effective antimicrobial.

Bacteria, Anaerobic↗
PubMed2006

[Role of probiotics in the prevention of neonatal necrotizing enterocolitis: A case-control study].

OBJECTIVE: To assess the role of probiotics in the prevention of neonatal necrotizing enterocolitis (NEC) and to investigate the risk factors for NEC. METHODS: A total of 2528 hospitalized neonates between January 2002 and May 2005 were assigned into either receiving prophylactic use of probiotics bifoco (Prevention group, n=1182) or without probiotics supplementation (Control group, n = 1346). The incidence of NEC was compared between the two groups. The risk factors for NEC were investigated by conditional logistic regression multifactorial analysis. RESULTS: There were 19 cases of NEC in the Control group (1.41%), but only 6 cases in the Prevention group (0.51%) (P < 0.05). Gestational age (OR = 5.521), hypoxicdouble ended arrowischemic encephalopathy (OR = 3.887), specticemia (OR = 4.854) and critical illness scores (OR = 5.989) were the risk factors for NEC, while the prophylactic use of probiotics was an independent protective factor for NEC (OR = 0.255). CONCLUSIONS: The prophylactic use of probiotics may reduce the incidence of NEC in neonates.

Case-Control Studies↗
PubMed1982

Neonatal necrotizing enterocolitis in the absence of pneumatosis intestinalis.

Necrotizing enterocolitis (NEC) may be diagnosed radiologically when pneumatosis intestinalis or hepatic-portal gas are present on abdominal roentgenograms. Of 136 patients with strictly documented NEC, 19 (14%) never demonstrated specific roentgenographic evidence of NEC. The diagnosis in these 19 patients was, however, confirmed by a histopathologic examination of tissue obtained at the time of laparatomy or autopsy. In 13 of these infants gastrointestinal (GI) perforation developed 12 hours to eight days following the onset of symptoms, while in five patients ascites developed as the only roentgenographic sign of potential intra-abdominal disease. We do not suggest that the vast majority of infants with mild abdominal distention or positive for occult blood have NEC. However, differentiating NEC from these other more common GI problems (such as feeding intolerances) is presently difficult in the absence of definitive roentgenographic evidence of pneumatosis intestinalis or histologic examination of the involved tissue.

Enterocolitis, Pseudomembranous↗
PubMed1985

Peritoneal neutrophilic cell response in necrotizing enterocolitis.

Neutropenia commonly occurs in neonates with necrotizing enterocolitis (NEC). In an attempt to determine the etiology of this neutropenia, we observed the peripheral and peritoneal neutrophil cell responses of seven infants at the time of surgery. Six of seven patients had diminished peripheral neutrophil counts within 24 hours prior to surgery, with substantial mobilization of mature neutrophils into the peritoneum. We also looked at the rat peritoneum as a model for neutrophilic cell consumption using casein and Vibrio cholerae enterotoxin to cause neutrophil mobilization. With both agents, significant mobilization of neutrophils into the peritoneum occurred. Bone marrow stores in the animals were substantially decreased, but neutropenia was not observed. We speculate that the neutropenia of NEC is largely a consequence of neutrophil mobilization into the peritoneum, perhaps initiated by dietary protein and/or bacterial toxin.

Agranulocytosis↗
PubMed1987

Surgery for necrotizing enterocolitis.

Thirty-seven patients who had necrotizing enterocolitis and required emergency surgical intervention are reviewed. The indications for surgery were intestinal perforation (28), intestinal obstruction (7), clinical deterioration (1) and persistent rectal bleeding (1). The initial procedure was percutaneous peritoneal catheter drainage (13), intestinal diversion alone (8), intestinal resection (14), laparotomy and biopsy (1) and laparotomy alone (1). Twelve patients developed late intestinal strictures. The overall mortality rate was 35 per cent.

Age Factors↗
PubMedDate not supplied

Necrotizing enterocolitis: a continuing problem in the neonate.

Necrotizing enterocolitis (NEC) is a syndrome of diverse etiologies with a significant mortality rate affecting mostly prematurely born stressed infants. Now recognized as a discrete entity, it had been poorly defined because other conditions seem to represent the same entity. A number of risk factors have been identified that appear to "trigger" NEC, though these have been questioned because they have been present just as frequently in premature and older infants who did not develop NEC as in those that did. Recently, maternal cocaine use has been added to the suspected risk factors. A steady improvement in the survival of babies with NEC has been due largely to a high index of suspicion of the disease and early, aggressive medical management.

Enterocolitis, Pseudomembranous↗
PubMed1982

Anaesthetic implications of neonatal necrotizing enterocolitis.

A retrospective analysis of infants with necrotizing enterocolitis was done to evaluate the effects of preoperative abnormalities upon anaesthesia and mortality. Mortality was significantly increased in infants weighing less than 1500 grams (p less than .001). Sixty-nine per cent of the infants had hyaline membrane disease and 35 per cent had platelet counts less than 50 X 10(9) cells/litre (50,000/mm3). Perioperative problems include peritonitis, sepsis, hypovolaemia, acidosis, and prematurity. Other ramifications of prematurity and anaesthesia are discussed.

Anesthesia↗
PubMed1980

Necrotizing enterocolitis following operation in the neonatal period.

Necrotizing enterocolitis (NEC) usually occurs in low birth weight infants who have had perinatal stress, and the mortality remains significant. There are a few reports of NEC in the postoperative period, especially in young infants. Nine neonates developed NEC following operations and form the basis of this report. The interval between operation and the diagnosis of NEC varied from 3 days to 4 mo. The surgical lesions included one case each of esophageal atresia, tetralogy of Fallot, supralevator rectal atresia with rectourethral fistula, and multiple intestinal atresias. Three babies had gastroschisis and two had "apple peel" intestinal atresia. Only 3 of the 9 survived. The usual clinical findings of NEC, abdominal distention, bile stained gastric residuals and diarrhea (with or without blood), can occur in the postoperative period without NEC and are, therefore, not reliable diagnostic signs. Significant changes in the clinical course of these babies occurred from 7 hr to 5 days before the diagnosis was established. In these patients the roentgen findings that established the diagnosis of NEC included intestinal ileus, pneumatosis intestinalis, and portal vein gas. Pneumatosis intestinalis and portal vein gas were the most reliable diagnostic signs, but appeared relatively late in the course of the disease. In one case pneumatosis was seen only in retrospect. None of the patients had definite pneumoperitoneum. Awareness of NEC as a potential postoperative complication may result in early recognition, treatment and survival.

Congenital Abnormalities↗
PubMed1984

Long-term assessment of growth, nutritional status, and gastrointestinal function in survivors of necrotizing enterocolitis.

The long-term effect of necrotizing enterocolitis on growth, nutritional status, and gastrointestinal function was assessed in premature infants at the age of 1 year. Of the 22 of 40 infants who developed NEC, 18 were given medical treatment and four required surgical treatment consisting of intestinal resection of less than one fourth of the small bowel. Eighteen infants who did not develop NEC served as controls. At 1 year follow-up, NEC survivors and controls had normal and comparable anthropometric measurements, biochemical values (serum iron, albumin, prealbumin, retinol binding protein, liver function studies) and gastrointestinal tract function (vitamin E absorption, fasting serum bile acids concentration, lactose breath test). This study demonstrates that, in the absence of short bowel syndrome, there is no detectable long-term effect on growth, nutritional status, and gastrointestinal tract function in premature infants who had NEC in the newborn period.

Anthropometry↗
PubMed1986

Necrotizing enterocolitis: treatment based on staging criteria.

Neonatal necrotizing enterocolitis is the most important cause of acquired gastrointestinal morbidity or mortality among low birthweight infants. Prematurity alone is probably the only identifiable risk factor. Although the etiology is unknown NEC has many similarities to an infectious disease. Proper staging helps improve reporting and the management of NEC.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Acute non-obstructive necrotizing enterocolitis in adults].

Acute non-obstructive necrotizing enterocolitis in adults is characterized by pathological features: it is an intestinal necrosis beginning in the mucosa, without obstruction of the mesenteric vessels. The disease occurs in a variety of circumstances which may be roughly divided into infections and fall in proximal or distal mesenteric flow rate, the infectious and circulatory mechanisms often coexisting. Little information on the diagnosis is provided by clinical and paraclinical data. Management is medical and/or surgical; it includes alleviation of the symptoms in intensive care unit, attempts at producing local vasodilation whenever possible and resection of the intestinal segment affected. In many cases the diagnosis is made at exploratory laparotomy. The prognosis is poor; it depends on the patient's age, on the extent of the lesions which sometimes require wide intestinal resections, and on the time to diagnosis.

Anti-Bacterial Agents↗
PubMed1998

Early detection of necrotizing enterocolitis by gastrointestinal tonometry.

The diagnosis of necrotizing enterocolitis (NEC) in neonates has traditionally depended on a combination of clinical signs, biochemical parameters and radiological changes. The measurement of intramucosal pH by gastrointestinal tonometry provides a simple means of long-term monitoring which may detect the development of NEC before conventional techniques. We present our experience of tonometry in two 'at risk' term neonates with Hypoplastic Left Heart Syndrome.

Enterocolitis, Pseudomembranous↗
PubMed1984

Vitamin B12 absorption after necrotizing enterocolitis.

Resection of the terminal ileum for necrotizing enterocolitis is not uncommon in neonates requiring intensive care in the first weeks of life. They may therefore be at risk of vitamin B12 malabsorption, and later of vitamin B12 deficiency. A method of measuring B12 absorption is described and the results are given. This assessment should be part of the follow up for all these children.

Child↗
PubMed1986

Acidosis and hepatic portal venous gas: indications for surgery in necrotizing enterocolitis.

A retrospective review of cases of necrotizing enterocolitis seen at the Children's Hospital National Medical Center during the past 5 years was performed to identify factors that indicate a need for surgical intervention. The study group consisted of 92 neonates. Persistent acidosis and hepatoportal venous gas were significantly more common in babies requiring surgery than in those who were managed medically. Other physical, radiologic, and laboratory factors did not occur more frequently in those children going to surgery. Neonates with hepatoportal venous gas or persistent acidosis should be treated aggressively, and surgical intervention should be considered early in this group. Such an approach may serve to reduce morbidity and mortality in the future.

Acidosis↗