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PubMed1985

Clostridial necrotizing enterocolitis.

In a bacteriologic investigation of infants with necrotizing enterocolitis (NEC), 16 of 50 infants had clostridia in cultures of blood or of peritoneal fluid obtained by paracentesis. Twenty-eight of the 50 infants had enteric bacteria other than clostridia, and six infants had sterile cultures. Of the 16 infants with clostridia, nine had C. perfringens and seven had other species of clostridia. Compared to infants with nonclostridial NEC, those with clostridial NEC were larger and more mature, had more extensive pneumatosis intestinalis and gangrene and more rapid progression of NEC. The nine infants with C. perfringens had a fulminant form of NEC, analogous to gas-gangrene of the intestine. Mortality in this group was 78% (7/9). The seven infants with clostridial species other than C. perfringens had a mortality comparable to that of infants with nonclostridial NEC (32%). Improved survival from NEC associated with C. perfringens may be possible only by prevention, rather than earlier diagnosis and improved heroic treatment.

Clostridium perfringens↗
PubMed1989

A standard of comparison for acute surgical necrotizing enterocolitis.

We reviewed 187 cases of documented neonatal necrotizing enterocolitis (NEC) from 1976 to 1988. Of these patients, 111 infants underwent celiotomy for acute surgical complications. The following protocol of operative indications was employed: pneumoperitoneum, localized mass, abdominal wall erythema, portal venous air, and clinical deterioration, singly or in any combination. Clinical deterioration was defined as falling platelet count, rising or falling white blood cell count, left shift in the myeloid series, persistently or progressively low pH, and increasing frequency of apnea or bradycardia. Overall mortality was 15% (28 of 187). For the patients who underwent celiotomy, all had histologic confirmation of NEC. Ninety-five had localized disease, and 16 had diffuse disease. All of the former had resection and diverting enterostomy with 85 (89.5%) surviving; none with diffuse disease survived, P less than 0.0001. Forty-one infants with NEC weighed less than 1,000 g; 25 underwent surgery and 15 (60%) survived. Fifty-one of the 159 surviving neonates (32%) developed intestinal strictures. All neonates with strictures have had resection and successful reconstruction of their gastrointestinal tract. These indications and surgical principles resulted in a high degree of diagnostic accuracy and a low degree of surgical mortality.

Clostridium↗
PubMed1998

Necrotizing enterocolitis after gastroschisis repair: a preventable complication?

BACKGROUND: Necrotizing enterocolitis (NEC) has been documented in up to 20% of infants after repair of gastroschisis and is responsible for significant morbidity. NEC is reported to occur up to 10 times more in preterm infants receiving standard formula compared with those who have been fed exclusively with breast milk. Does breast milk confer a similar protection against NEC in infants who have undergone surgery for gastroschisis? METHODS: All newborns with gastroschisis delivered between 1990 and 1996 and treated in a single neonatal unit were analyzed retrospectively. Clinical data, details of feeding regimens, and episodes of definite NEC were recorded. RESULTS: Of 60 infants with gastroschisis, 6 (10%) died but none had evidence of NEC. Of the remaining 54 infants, clinical and radiological signs of NEC developed in 8 (15%). All recovered with medical treatment including the three patients with recurrent episodes. NEC developed in none of the 12 babies exclusively fed with expressed breast milk (EBM) in contrast to 1 (5%) of the 19 who received both EBM and formula, and 7 (30%) of the 23 who were fed solely on formula. There was no significant difference in gestation, incidence of primary versus silo closure, or incidence of intestinal atresia/stenosis in those with NEC (n=8) compared with those without (n=46), but birth weight in the NEC group was lower. NEC was less likely to develop in infants who received EBM than those who were exclusively formula fed (P < .02). CONCLUSION: After gastroschisis repair, feeding with maternal expressed breast milk may help to protect the infant from developing NEC.

Abdominal Muscles↗
PubMed1975

Necrotizing enterocolitis.

The clinical course of 54 patients with necrotizing enterocolitis has been compared to a matched group of 98 control patients. On the day of life that NEC occurred, all 54 NEC patients and 63% of controls were receiving standard formula feedings, both at 80/cal/kg/day. Stool cultures at the time revealed a significantly increased frequency of Klebsiella in NEC as compared to control patients. Our data suggest that the combined presence of certain intestinal bacteria and enteric feedings, perhaps requiring a background of mucosal ischemia, may be of etiologic significance in the development of NEC and its radiologic hallmark, pneumatosis intestinalis.

Birth Weight↗
PubMed1976

Necrotizing enterocolitis in term infants.

Despite the fact that necrotizing enterocolitis is considered a disease of premature infants, 20% of all affected infants at Babies Hospital over the past 20 years were products of term gestations. Two distinct subgroups of such infants were noted (1) five infants with congenital heart disease and/or congestive heart failure (e.g.hypoplastic left heart syndrome), all but one of whom developed the disease in the first week of life; (2) eight infants who developed the disease at a much later age after a protracted period of diarrhea. This histopathologic features of the disease in term infants are the same as those in premature infants. Further, the pathogenesis of the disease in term infants does not appear to differ basically from that in premature infants. These facts, lead away from the concept of NEC as a disease of simple etiology.

Diarrhea, Infantile↗
PubMed1993

Necrotizing enterocolitis. New thoughts about pathogenesis and potential treatments.

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in premature infants. An incomplete understanding of its pathogenesis has hampered efforts to devise an effective preventative strategy. New insights into the pathogenesis of NEC, particularly at the cellular and biochemical level, however, offer a rational basis for the development of new approaches to this disease.

Adrenal Cortex Hormones↗
PubMed1985

Necrotizing enterocolitis in pulmonary atresia with intact ventricular septum.

Necrotizing enterocolitis (NEC) occurred in 2 neonates with pulmonary atresia and intact ventricular septum. Both infants underwent open heart surgery for the insertion of a right ventricular outflow tract patch under profound hypothermia, surface cooling and a fibrillating heart, without circulatory arrest. In both patients the development of NEC preceded both the cardiac catheterization study and open heart surgery. Urgent repair of the cardiac lesion was undertaken in an attempt at improving the critical bowel wall ischemia. Postoperatively, exacerbation of the NEC reached an advanced stage rapidly leading to the death of the patients. Recommendations regarding the management of future cases exhibiting this potentially lethal combination of disease are presented.

Adult↗
PubMed1981

[Atresia and obliteration of the small bowel in cases of necrotizing enterocolitis (author's transl)].

As a result of necrotizing enterocolitis, one patient developed multiple obliterations of jejunum and ileum, partly over long stretches of bowel. In a second case of a neonate with enterocolitis necroticans, an ileum atresia formed in the second and third weeks of life, completely interrupting the continuity of the intestine. In the literature, we could only find one report comparable with each case.

Enterocolitis, Pseudomembranous↗
PubMed1993

The effect of abdominal incisions on early motor development of infants with necrotizing enterocolitis.

Eighteen very low-birthweight infants with necrotizing enterocolitis (NEC) underwent periodic neurodevelopmental testing until two years of age. They were grouped according to whether they had had surgical intervention (N = 6) or non-surgical therapy (N = 12). At eight and 15 months corrected age, a significantly greater number of the surgical group exhibited motor delay. At 24 months, only one infant in the surgical group had persistent motor delays. These findings indicate a higher incidence of motor delays in infants requiring surgery for NEC. The delays involved skills influenced by the abdominal musculature. These motor delays persisted up to 24 months, but appeared to resolve with time.

Abdominal Muscles↗
PubMed1984

Necrotizing enterocolitis in the first 24 hours of life.

Necrotizing enterocolitis (NEC) is commonly thought of as occurring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 +/- 849 g), more mature (mean gestational age 37.9 +/- 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 +/- 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 +/- 586 g, mean gestational age 32.0 +/- 3.5 weeks, P less than .001, and mean five-minute Apgar score 6.81 +/- 1.84, P less than .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.

Apgar Score↗
PubMed1978

[Roentgen diagnosis of necrotizing enterocolitis in the newborn (author's transl)].

The necrotizing enterocolitis in the newborn is a life threatening disease which is probably induced by stress to the mother or child. Mostly it occurs in the second week of life. After initial non specific symptoms rapid detoriation occurs with distended abdomen, blood diarrhea, bileous vomiting, rapid impairment, septicemia and shock. Careful clinical observation and interpretation of the roentgen signs as intramural gas collection in distended bowel loops (pneumatosis intestinalis) with air fluid levels, gas collection in the portal vein, ascites, free air in the abdomen after viscus perforation can improve the unfavorable prognosis when the correct diagnosis is made and adequate therapy is started in time.

Enterocolitis, Pseudomembranous↗
PubMed1977

Necrotizing enterocolitis in Black neonates.

Several years ago neonatal necrotizing enterocolitis (NNE) was commonly seen in an open ward for premature babies at Baragwanath Hospital, which was affected by recurrent outbreaks of gastro-enteritis and Salmonella infections. Since outbreaks of infection have been prevented, NNE has been uncommon, in spite of a high incidence of babies of low birth weight, many of who experience neonatal shock from anoxia and hypothermia, conditions considered as predisposing to NNE. The animal experimental work on the protective function of breast milk against NNE is discussed, and it is suggested that the low incidence of NNE at this hospital is due to the establishment of breast milk banks and the encouragement of breast feeding for all neonates.

Black or African American↗
PubMed1976

Necrotizing enterocolitis after open heart surgery employing hypothermia and cardiopulmonary bypass.

Three patients, 1-11 months of age, who underwent open heart surgery with cardiopulmonary bypass and profound hypothermia, developed necrotizing enterocolitis postoperatively leading to death. Pneumatosis intestinalis and portal vein gas were demonstrated radiographically. Necrotizing enterocolitis has not been previously reported as a complication of cardiopulmonary bypass and profound hypothermia.

Air↗
PubMedDate not supplied

Necrotizing enterocolitis of the newborn.

The clinical presentation, diagnostic features, therapeutic measures, and results of treatment of 29 infants with the firmly established diagnosis of necrotizing enterocolitis are reviewed. A cohort of control patients are studied in an attempt to identify risk factors which may predispose infants to develop this serious complication of the newborn period. The incidence of necrotizing enterocolitis in our series is 1.2 per 1000 live births, similar to that reported by other investigators. The prognosis is particularly grave in infants of very low birth weight and among those who exhibit radiographic evidence of portal venous air or who develop disseminated intravascular coagulation.

Apgar Score↗
PubMed2006

Surgical necrotizing enterocolitis and intraventricular hemorrhage in premature infants below 1000 g.

BACKGROUND/PURPOSE: Infants with very low birth weight are at increased risk for both intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). IVH often progresses in severity after initial diagnosis and causes severe neurological morbidity and mortality. The authors examined the role of NEC in the progression of IVH in these infants. METHODS: The authors conducted a retrospective case-control study using data from the University of Maryland neonatal intensive care unit database between 1991 and 2003. From a cohort of 957 infants with very low birth weight, 53 pairs of infants labeled as IVH progression versus controls were selected and closely matched in respect to their gestational age and birth weight. Charts from these infants were reviewed to identify risk factors contributing to IVH progression. RESULTS: Infants with IVH progression were significantly more likely to suffer from NEC (odds ratio, 3.6), whereas infants with surgical NEC showed a greater association with IVH progression (odds ratio, 5.33). Association with thrombocytopenia was also seen (odds ratio, 3.33). Sepsis showed trend toward significance (odds ratio, 1.9; P = .095) for progression of IVH. CONCLUSION: Surgical NEC showed the greatest risk for IVH progression. NEC and thrombocytopenia also appear to be risk factors for IVH progression.

Case-Control Studies↗
PubMed1995

Patient assessment skills: assessing early cues of necrotizing enterocolitis.

A study is presented utilizing the critical decision method to elicit knowledge from neonatal intensive care unit nurses regarding the assessment of infants at risk for necrotizing enterocolitis. Researchers were successful in eliciting knowledge not available in current nursing texts, including a framework for considering necrotizing enterocolitis and problem-solving strategies used by experienced nurses. Implications for nurse instruction and potential applications of this information are discussed.

Cues↗
PubMed1986

Necrotizing enterocolitis in infants of multiple gestation.

We examined the records of ten pairs of twins and one set of triplets among whom one or more infants had necrotizing enterocolitis (NEC). Perinatal asphyxia and respiratory distress were less common in the firstborn infants. It might, therefore, be anticipated that necrotizing enterocolitis was less common in this group. We found the reverse to be true. In all of the twin pairs twin A had NEC, and in no case did only twin B have NEC. The disease developed in triplet B but not in triplets A or C. Examination of associated risk factors revealed that the firstborn infants were more stable, were fed sooner, and had feedings advanced somewhat more rapidly than their counterparts. We re-emphasize that there are unrecognized risk factors in the pathogenesis of NEC and that a high index of suspicion should be maintained for all premature infants despite their apparent stability.

Birth Order↗