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PubMed1999

Necrotizing enterocolitis in omphalopagus conjoined twins.

Female omphalopagus twins underwent laparotomy on the second day of life after an antenatally diagnosed high jejunal bowel obstruction. Bowel resection and choldocho-enterostomies were performed. Despite recovery from laparotomy, the development of severe necrotizing enterocolitis (NEC) in one twin led to rapid deterioration and the death of both infants on day 34. The elucidation of the combined biliary tree, the dilemma of NEC in conjoined twins, and the possibilities of emergency separation are discussed. Consideration should be given to emergency separation of conjoined twins in the event of potentially lethal complications.

Enterocolitis, Necrotizing↗
PubMed2003

Necrotizing enterocolitis and gastrointestinal complications after indomethacin therapy and surgical ligation in premature infants with patent ductus arteriosus.

BACKGROUND: Indomethacin is the most frequently used pharmacological agent for closure of a patent ductus arteriosus (PDA) in premature infants. However, reports of complications, particularly, necrotizing enterocolitis (NEC) and isolated gastrointestinal perforation have generated concerns about the use of this medication. OBJECTIVES: A retrospective study to compare the incidence of NEC, NEC-related gastrointestinal complications and isolated gastrointestinal perforation among premature infants treated for a PDA with either, indomethacin alone (I), surgical ligation alone (L), or indomethacin followed by surgical ligation (I-L). METHODS: The medical records of 224 infants that underwent treatment, either pharmacological or surgical, for a PDA, confirmed by echocardiography, over a 4-year period (1995 to 1998) were analyzed. Treatment history and gastrointestinal complications were reviewed. RESULTS: Of the 224 infants, 108 (48.2%) were treated with I, 50 (22.3%) by L, 66 (29.5%) with I-L. The clinical characteristics of the three treatment groups were similar and no differences in the incidence of NEC were observed between groups. NEC occurred in 14 (13%) of the I group, seven (14%) of the L group, and eight (12%) of the I-L group. The rate of NEC related gastrointestinal complications and isolated gastrointestinal perforation were also similar among groups. CONCLUSION: In this large retrospective study, indomethacin treatment for a significant PDA in premature infants was not associated with a greater risk for NEC or NEC-related gastrointestinal complications than surgical ligation.

Birth Weight↗
PubMed1980

Neonatal necrotizing enterocolitis: the relation of age at the time of onset to prognosis.

A study was undertaken to evaluate the predisposing factors, age at the time of onset and prognosis of neonatal necrotizing enterocolitis in 62 patients treated in a neonatal intensive care unit during a 5-year period (1974-78). Because of a peak frequency during the first week of life, the cases were divided into those of early-onset illness (appearing within the first week of life) and those of late-onset illness (appearing after this week). The main differences between the two groups were in the age at the time of the first enteric feeding (1.6 +/- 0.9 d v. 40 +/- 2.4 d [mean +/- one standard deviation]; P less than 0.001) and the interval between this feeding and the onset of symptoms (3.0 +/- 1.5 d v. 10.6 +/- 6.0 d; P less than 0.01). Furthermore, the early-onset illness was more severe, more often necessitating surgical intervention and carrying a higher mortality, than the late-onset illness. Thus, this study demonstrates that there are two forms of neonatal necrotizing enterocolitis, differing in time of appearance after birth as well as in severity and prognosis.

Age Factors↗
PubMed1984

A widespread epidemic of mild necrotizing enterocolitis of unknown cause.

Within a 28-day period, necrotizing enterocolitis (NEC) developed in 20 of 38 infants (53%). Patients with NEC were compared with the remaining 18 infants hospitalized at the same time who did not acquire the disease. Complications of pregnancy and labor-delivery and infant care practices did not differ between groups. Mean chronologic age was significantly different between patients with NEC and those without, 29 days v 77 days. Mean postconceptional age at the time of the outbreak was also significantly different, 33.4 weeks v 42.3 weeks. None of the cultures demonstrated a specific common pathogen. The low mortality (5%) and the large number of infants affected suggest an atypical out-break of NEC. We could not isolate a causative agent despite extensive epidemiologic investigation, and suggest that postconceptional age delineates those at risk.

Age Factors↗
PubMed1990

Results of surgical treatment of neonatal necrotizing enterocolitis.

In 6 years, 74 neonates were treated for necrotizing enterocolitis, 40 (54 per cent) of whom underwent operation. The early postoperative mortality rate was 23 per cent and there was one late death. Of the 30 postoperative survivors, two have short bowel syndrome, two have chronic respiratory disease, two are partially sighted, and five (17 per cent) have severe developmental delay. Only 15 (50 per cent) survivors enjoy good health.

Abnormalities, Multiple↗
PubMedDate not supplied

Balloon catheter dilatation of focal colonic strictures following necrotizing enterocolitis.

Two infants with severe colonic strictures secondary to necrotizing enterocolitis (NEC) were successfully dilated with balloon catheters. The procedures were performed under mild sedation, with fluoroscopic guidance. Results were sustained for more than 4 years follow-up. This procedure proved to be a safe and effective alternative to operative repair.

Catheterization↗
PubMed1977

Necrotizing enterocolitis occurring in an infant three months of age.

Necrotizing enterocolitis (NEC) is usually described as occurring in newborn premature of low-birth-weight infants who have been stressed by hypoxia, exchange transfusion, or severe sepsis. It occasionally occurs in full term neonates. The age of onset is between day 1 and day 35. This communication describes the occurrence and course of NEC in a 3 mo old infant with a short intestine.

Colon↗
PubMed1983

Resection with primary anastomosis for necrotizing enterocolitis.

Primary anastomosis following the resection of bowel for necrotizing enterocolitis (NEC) can be done with acceptable morbidity and mortality rates. Twenty-seven patients are reported with three deaths. Primary anastomosis will avoid problems seen with small-bowel stomas. The concomitant ligation of a significant patent ductus arteriosus (PDA) should be considered for patients undergoing abdominal procedures for NEC.

Ductus Arteriosus, Patent↗
PubMed1979

Necrotizing enterocolitis in neonates fed human milk.

The incidence of necrotizing enterocolitis encountered in neonates fed only refrigerated human milk was comparable to that in infants fed milk and isotonic formula or isotonic formula alone. The infants fed human milk were significantly (P less than 0.05) smaller, less mature, had lower Apgar scores, and were fed later than the formula-fed infants. The mean age of onset and time between first feeding and onset of NEC was similar among the three groups. These data indicate that refrigerated human milk was not effective in lowering the incidence of NEC. Possible explanations for the occurrence of NEC in neonates fed human milk include: (1) the introduction of a pathogen via contaminated milk; (2) inadequate maternal antigenic stimulation by the neonatal gastrointestinal flora; and (3) adverse affects of storage on cell number and function.

Enterocolitis, Pseudomembranous↗
PubMed1984

Surgical therapy for necrotizing enterocolitis.

Fifty-one infants were treated surgically for necrotizing enterocolitis utilizing a uniform protocol from July 1980 through July 1983. The indications for surgery were pneumoperitoneum or a paracentesis indicative of bowel infarction. Segmental intestinal resection and exteriorization of the bowel ends through the upper abdominal transverse incision was the usual procedure. Intestinal continuity was reestablished when the patient reached 10 pounds, or sooner if he was failing to thrive with his ileostomy. The overall survival was 72.5%, and it was 82% for those patients have a definitive surgical procedure. This survival rate was not adversely affected by the patient's weight or age at the time of operation, nor by the presence of bowel perforation. The 37 survivors endured multiple postoperative complications. The most significant long-term sequela was short-gut syndrome, which occurred in 11% of survivors.

Age Factors↗
PubMed1991

Differences in the clinical and radiologic patterns of rotavirus and non-rotavirus necrotizing enterocolitis.

We analyzed retrospectively 32 successive infants who developed necrotizing enterocolitis (NEC), 13 with rotavirus (RV) infection (RV+) and 19 RV-negative (RV-). All patients showed at least pneumatosis intestinalis. All patients except one had risk factors for perinatal asphyxia. Our study demonstrated significant differences between RV+ NEC and RV- NEC cases: RV+ NEC infants had a higher birth weight and were born at a later gestational age. Oral feeding was started earlier and symptoms developed later and more insidiously in RV+ patients than in RV- NEC babies. Radiology revealed a less severe and more distal colon involvement in RV+ NEC infants, whereas the RV- NEC patients mostly had small intestinal or ileocecal changes and more frequent complications of pneumoportogram and intestinal perforations. These latter infants often had a rapidly deteriorating clinical course; 84% needed surgical treatment. In conclusion RV may be a cause of NEC in susceptible infants. Historic and clinical data and a more distal colonic pneumatosis allow a differentiation of RV+ NEC from other forms of NEC.

Anti-Bacterial Agents↗
PubMed1995

Neurodevelopmental outcome in very low birthweight infants with necrotizing enterocolitis requiring surgery.

OBJECTIVE: To assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome. METHODOLOGY: Neurodevelopmental outcome of 20 very low birthweight (VLBW) infants who developed NEC requiring surgery was compared with 40 matched infants controlled for gestation, birthweight, and year of admission. Twenty-nine VLBW infants who developed NEC and did not require surgery were also compared. RESULTS: Infants with NEC needing surgery were of 26 +/- 2 weeks gestation and weighted 892 +/- 192 g at birth. Infants with NEC managed medically were of higher gestation (27 +/- 2 weeks) but similar birthweights. More infants with NEC requiring surgery required inotropic support. At follow up, NEC surgery infants had a significantly higher incidence of developmental morbidity. 11 of 20 compared with 11 of 40 matched controls (Fisher's exact test P = 0.0493), and six of 29 infants with NEC managed medically (Fisher's exact test P = 0.0174). CONCLUSIONS: These findings stress the importance for close follow up for neurodevelopmental sequelae in VLBW infants who have had NEC requiring surgery.

Blindness↗
PubMed1994

Neonatal necrotizing enterocolitis, a disease of the immature intestinal mucosal barrier.

Necrotizing enterocolitis (NEC) is an enigmatic process in that one single etiologic factor has been sought and not found. Epidemiologic studies suggest that immaturity of the host plays a very important role. This article reviews the intestinal host defense system and its immature nature early in life in animal models and humans and suggests that it is this immaturity, along with other factors, which allows for the proliferation and invasion of antigens and organism, and the subsequent development of NEC. Data are presented which support the efficacy of pharmacologic maturation of the intestinal barrier with growth factors, either prenatally or postnatally, to decrease the incidence of NEC or, potentially, to provide a more benign course for the disease.

Animals↗
PubMed1978

Bowel stenosis as a late complication of acute necrotizing enterocolitis.

Bowel stricture as a late complication of acute necrotizing enterocolitis in 10 neonates is discussed with respect to time interval to development, number of strictures, location, sexual and racial distribution and possible contributing factors. This is compared with previous reports in the literature. Differences in the distribution of acute and late sites of involvement are discussed.

Colonic Diseases↗
PubMed1990

Neonatal necrotizing enterocolitis: air in Morison pouch.

Six newborn infants with necrotizing enterocolitis (NEC) were noted to have air confined to Morison pouch as an early sign of pneumoperitoneum. Air in Morison pouch appears as a triangular lucency in the right upper quadrant. Extraluminal air in this location is easily mistaken for air within a loop of bowel if its characteristic appearance is not specifically sought. Review of the literature revealed no reported cases of NEC in which air in Morison pouch was mentioned. The authors' observation of six patients suggests that air in Morison pouch may be more common than previously recognized. Air in Morison pouch has the same significance as more obvious signs of pneumoperitoneum, and its detection is an indication for surgery.

Colonic Diseases↗
PubMed1979

[Intestinal obstruction following necrotizing enterocolitis (author's transl)].

The increase in survival from necrotizing enterocolitis results in an increased rate of late sequelae. We would like to take the opportunity to emphasize these new complications by a review of our patient material. 11 (23.9%) patients from a total number of 46 showed signs and symptoms of intestinal obstruction at different points in the course of the disease. In two surviving patients out of this group of 11, a resection of postinflammatory gut stenosis had to be performed within the first year. In the 9 children who died, particular emphasis is being paid in the autopsy reports to obstructive lesions in the gastrointestinal tract. Due to this rather frequent event (23.9%) of postinflammatory formation of strictures and stenoses in the recovery from NEC a functional radiographic study of the intestinal patency seems mandatory before discharge of any patient with NEC with operative or conservative treatment.

Enterocolitis, Pseudomembranous↗