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PubMed1980

Colonic stricture following necrotizing enterocolitis.

There has been a steady increase in the incidence of necrotizing enterocolitis (N.E.C.). Early diagnosis and prompt surgical intervention have improved the mortality considerably (8). With the increasing number of survivors, late complications are more frequently encountered. Three neonates who had developed strictures of the colon 3, 4 and 6 weeks respectively, after the onset of the acute episode of N.E.C. are reported and showed interesting features, an extensive long stricture and a tight short stricture which simulates a colonic atresia.

Colonic Diseases↗
PubMed1989

A review of 36 babies with necrotizing enterocolitis.

The clinical features, management, and outcome of 36 babies with necrotizing enterocolitis seen over 5 years at the Neonatal Unit, Mount Hope Women's Hospital, Trinidad, are described. The crude overall mortality rate was 25 per cent. The results suggest that prematurity, sepsis, and umbilical catheterization, but not enteral feeding or polycythaemia may be involved in the aetiology of this disease.

Combined Modality Therapy↗
PubMed1979

Bacteriologic considerations in perforated necrotizing enterocolitis.

During a ten-year period, 61 infants with perforated necrotizing enterocolitis were managed by bowel resection, enterostomy, and intravenous antibiotics. Aerobic and anaerobic cultures were taken of venous blood, from the peritoneal cavity at operation, and of any subsequent wound and/or intraperitoneal infection. No significant differences between fatal and nonfatal cases were noted with respect to presence of anaerobes in the peritoneal flora (six babies with two deaths) or culture-confirmed bacteremia (73% of the total). However, peritonitis participated in by Pseudomonas aeruginosa (ten babies), or beta-hemolytic streptococcus (five babies) was -niformly lethal, as were complicating bacteremias due to P aeruginosa, beta-hemolytic streptococcus, and Staphylococcus aureus (two each). Anaerobic peritoneal isolates (all gram-positive cocci) were never noted if performation occurred before the eighth day of life; they did not appear to adversely affect survival. Based upon these data, antibiotic therapy should include either gentamicin or tobramycin, with penicillin, until subsequent culture reports dictate otherwise.

Bacteria↗
PubMed1991

Prevention of necrotizing enterocolitis in neonates at risk by oral administration of monomeric IgG.

Necrotizing enterocolitis (NEC) represents one of the major causes of morbidity in low-birth-weight (LBW) preterm infants. This randomized clinical trial evaluated the efficacy of an oral immunoglobulin preparation (containing monomeric IgG in a concentration of 90%) in reducing the incidence of NEC in infants of LBW for whom maternal breast milk was not available. One hundred and thirty-two formula-fed newborns with a birth weight less than or equal to 1,500 g or a gestational age less than or equal to 34 weeks were randomly studied. Five hundred mg of IgG pro die, subdivided into 5 doses, were given orally to the test group of 65 neonates during the first 2 weeks of life. Although the number of infants included in this group is limited, the results of this study are encouraging: during the first 15 days after birth, none of the subjects developed NEC, while 4 cases were confirmed in the untreated control group. It, therefore, seems possible that oral monomeric IgG administration may prevent the development of NEC in LBW infants.

Administration, Oral↗
PubMed1977

Neonatal necrotizing enterocolitis: 1. Clinical aspects.

Forty-infants were diagnosed as having necrotizing enterocolitis (NEC) during a 33 months' period; these represented 4% of all neonatal admissions. Pathological confirmation was obtained at surgery in 12 cases and at autopsy in 11, In the case of 21 infants who recovered without operation, the diagnosis was based on clinical and radiological criteria inculding the presence of intramural gas. NEC occurred primarily, though not exclusively , in low-birth-weight infants. Two-thirds of the infants developed NEC in the first week of life. Clinical features attributable to gastrointestinal malfunction as well as a systemic illness could be defined. Complications included pneumoperitoneum (34%), localized peritonitis as suggested by the development of an abdominal mass (11%) and intestinal obstruction (25%). Fourteen of the 15 cases of pneumoperitoneum were diagnosed within 24 hours after the onset of NEC. The 5 infants were localized peritonitis, who were managed conservatively initially, developed intestinal obstruction during recovery. Intestinal obstruction presented between 2 and 7 weeks after the onset of NEC. The overally mortality was 25%, infants with intestinal perforation or obstruction having and increased mortality of 38%.

Age Factors↗
PubMed1987

[Intestinal stenosis, sequelae of necrotizing enterocolitis. Analysis of 9 cases].

Intestinal necrosis was a complication of necrotizing enterocolitis of the newborn in 9 of 42 cases. In 6 neonates it followed medical treatment of the enterocolitis, presenting in this case as an occlusive syndrome. After surgical treatment (3 cases) the diagnosis was made from radiologic imaging prior to reestablishment of digestive continuity. Surgery was necessary in all cases, and procedures used are described (technic, date of operation). The prognosis of enterocolitis is worsened by this stenosis (1 death in the 9 cases).

Enterocolitis, Pseudomembranous↗
PubMedDate not supplied

[Neonatal necrotizing enterocolitis (author's transl)].

Authors present analysis of 31 cases of necrotizing enterocolitis, which where treated medically as well surgically. Etiology is discussed and perinatal accidents are considered. An analysis of symptomatology and radiological study is made, both being deciding factors as to whether a surgical intervention is necessary. Medical treatment is commented as well as surgical and technical aspects. Mortality is sensibly diminished due to a better knowledge of the illness and to a closer cooperation between neonatologist and surgeon. It is important to point out sequelae which appeared in patients treated medically with intestinal stenosis localized in the colon.

Colonic Diseases, Functional↗
PubMed1996

Inflammatory cytokines, nitric oxide, and necrotizing enterocolitis.

Numerous theories have been proposed to explain the pathogenesis of necrotizing enterocolitis (NEC). Current evidence suggests that injury to the intestinal barrier as a result of various perinatal insults may facilitate invasion of the intestinal wall by bacteria. An inflammatory cascade ensues, characterized by local release of various cytokines that may contribute to further tissue destruction and hemodynamic instability in NEC. Molecular biological probes show increased expression of inducible nitric oxide synthase and interferon-gamma in the intestine of infants with NEC. Studies are planned to define the role of these inflammatory mediators in a rat model of NEC.

Animals↗
PubMed1997

Laparotomy or drain for perforated necrotizing enterocolitis: who gets what and why?

Between 1974 and 1988, 86 newborns with perforated necrotizing enterocolitis (NEC) were treated by either laparotomy (usually involving a bowel resection and a temporary stoma) or a peritoneal drain under local anesthesia. The survival of babies in the laparotomy group was 57% versus 59% in the drained group. However, for neonates less than 1,000 g survival in the drained group was 69% compared to 22% for the laparotomy group (P <.01). As the weight of the babies increased over 1,000 g, the survival in the laparotomy group increased to 67%. There was no significant increase in survival in infants over 1,500 g. The highest neonatal mortality risk is generally found among babies weighing less than 1,000 g at birth with a gestational age of less than 30 weeks. This risk increases even more when perforated NEC is added to the prematurity. With the use of peritoneal drainage, survival in this group can approach that of larger neonates.

Journal Article↗
PubMed1997

Laparotomy or drain for perforated necrotizing enterocolitis: who gets what and why?

Between 1974 and 1988, 86 newborns with perforated necrotizing enterocolitis (NEC) were treated by either laparotomy (usually involving a bowel resection and a temporary stoma) or a peritoneal drain under local anesthesia. The survival of babies in the laparotomy group was 57% versus 59% in the drained group. However, for neonates less than 1,000 g survival in the drained group was 69% compared to 22% for the laparotomy group (P <.01). As the weight of the babies increased over 1,000 g, the survival in the laparotomy group increased to 67%. There was no significant increase in survival in infants over 1,500 g. The highest neonatal mortality risk is generally found among babies weighing less than 1,000 g at birth with a gestational age of less than 30 weeks. This risk increases even more when perforated NEC is added to the prematurity. With the use of peritoneal drainage, survival in this group can approach that of larger neonates.

Drainage↗
PubMedDate not supplied

Alterations of the enteric nervous system in neonatal necrotizing enterocolitis revealed by whole-mount immunohistochemistry.

Pathology reports on neonatal necrotizing enterocolitis (NNEC) rarely consider its effects on the enteric nervous system (ENS). Thus, the aim of this study has been to perform a two-dimensional assessment of neuropathologic lesions within the three ganglionated plexuses of the intestinal wall by means of whole-mount immunohistochemistry. Resected segments of ileum and colon affected by acute NNEC were submitted to immunohistochemical procedures using antibodies against neuronal (protein gene product 9.5) and glial (protein S-100, glial fibrillary acidic protein) proteins. Examination of the myenteric plexus and external submucosal plexus revealed a noticeable reduction in glial cells concomitant with the gradual deterioration of nerve cells, both findings predominating in the antimesenteric intestinal circumference, where ischemic lesions tend to appear first. The most severe damage of nervous tissue was observed in the plexus submucosus internus dependent on the depth of mucosal injury. The destroyed ganglia appeared like "empty baskets" (residual tangles) and housed deteriorated nerve and glial cells. Taking the anatomy of the intestinal vascular blood supply into consideration, the characteristic topography of neuropathologic lesions gives further support to an ischemic event within the cascade of different pathogenetic factors culminating in NNEC. Moreover, the demonstrated alterations of the ENS and their potential adverse effects on intestinal motility and neuroimmunologic interactions may contribute to the complex pathogenesis of NNEC, which remains a field of further investigation.

Enteric Nervous System↗
PubMed1998

Neonatal necrotizing enterocolitis: the long-term perspective.

Ten years' experience with neonatal necrotizing enterocolitis (NNEC) was reviewed retrospectively to determine long-term survival and quality of life and to analyze risk factors associated with in-hospital mortality. Institutional records were queried to identify all neonates who required emergent surgical intervention for NNEC. These records were then reviewed and survivors' families interviewed by phone to determine patient status, persistent gastrointestinal problems, and overall quality of life. Once identified, long-term survivors (LTSs) were compared to in-hospital deaths by the analysis of birth weight, gestational age, time interval from birth to diagnosis, indications for laparotomy, and extent of intestinal involvement. Between 1986 and 1996, 69 patients required surgical intervention for NNEC. Eleven patients were lost to follow-up. Of the remaining 58 patients, 31 were ultimately discharged home, with 28 patients having survived an average of 4.18 years. The acute, or in-hospital, mortality rate was 39.1 per cent. Infants who died did so within an average of 23 days postoperatively, and those who were discharged home required an average of 121 days of inpatient convalescence. Twenty-one of the 28 LTSs achieved a normal quality of life with no persistent health problems. One patient required a hepatic-intestinal transplant, and another six had minor problems with frequent diarrhea. Average birth weight, age at NNEC diagnosis, and gestational age were not significantly different between LTSs and those with acute deaths. Aggressive in-hospital care is warranted for infants with NNEC. The excellent quality of life achieved in 75 per cent of survivors implies that the expense of heroic surgical care for these seriously ill premature infants is a worthwhile investment.

Birth Weight↗
PubMed2004

[Necrotizing enterocolitis in extremely immature newborns. The surgical treatment potential].

AIM: The aim of this study is to assess a contemporary treatment potential for necrotizing enterocolitis in newborns with birth weights under 1000 g. METHODOLOGY AND SUBJECTS: This is a retrospective study of clinical and pathological data in a group of 19 newborns with birth weights under 1000 g treated for necrotizing colitis (NEC) by the authors' team from 1999 to 2003. Only newborns with the second and third grade NEC according to Bell were included in the trial group. RESULTS: The trial group included 19 newborns born in the 26th gestation week, on average (ranging from 23- to 31) with a mean birth weight of 711 grams (the range between 460-980 g). Their NEC appeared on the 18th postnatal day, on average (the range between 6-59). Ten newborns were operated in the acute stage of their NEC, nine were treated conservatively. Five infants operated in the acute stage had separational ileostomy conducted, four had a T-drain introduced and one had an abdominal drain introduced. In the conservatively managed group, three infants were consequently operated for intestinal strictures following their NEC, two recovered during the conservative treatment and four exited due to a fast progress of their NEC without surgery. The total mortality rate of the trial group was 42% (8 infants exited). CONCLUSION: The NEC treatment in the extremely immature newborns with birth weigts under 1000 g requires complex cooperation of a neonatologist and a paediatric surgeon. The necrotic intestine resections followed by stomic procedures remain standard procedures in unstable newborns with a localised form of the disease.

Enterocolitis, Necrotizing↗
PubMed1983

Hexosaminidase: a marker for intestinal gangrene in necrotizing enterocolitis.

Detection of intestinal ischemia, prior to necrosis, is a major clinical problem. The lysosomal acid hydrolase, hexosaminidase (HEX), is known to be elevated in intestinal infarction. To determine if this enzyme could differentiate between partial intestinal ischemia and full-thickness intestinal gangrene, the following rat study was designed. Partial segmental intestinal ischemia was created by ligating alternate vascular bundles over a short (6 vessel) segment of the small-bowel mesentery, and complete segmental intestinal vascular occlusion was achieved by ligating the blood supply to the ileocecal segment. Preoperative serum HEX values were obtained from 15 animals. The rats were separated into one sham-operated and two intestinal ischemia groups. At four hours after surgery HEX values were determined. Total HEX activity was significantly elevated four hours after insult in both partial and complete intestinal ischemia, (P less than 0.005 and P less than 0.001 respectively). Total HEX activity was greater in complete intestinal ischemia than in partial ischemia, (P less than 0.05). Three neonates with intestinal perforation, secondary to necrotizing enterocolitis, were evaluated. The mean preoperative HEX activity was 1421 nmol/hr/mL serum and the mean post-resection HEX activity was 808 nmol/hr/mL serum. These data suggest that serum HEX activity may be a good marker for intestinal gangrene in neonates with necrotizing enterocolitis.

Animals↗
PubMed2003

Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis.

UNLABELLED: Spontaneous intestinal perforation (SIP) has been increasingly reported in very-low-birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one-third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole-bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans. CONCLUSION: This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover.

Adult↗
PubMed1981

Neonatal necrotizing enterocolitis: a nine-year experience.

To gain an epidemiologic perspective on necrotizing enterocolitis (NEC), nine years' experience with 123 patients was reviewed. Mean gestational age was 31 weeks, and mean birth weight, 1,460 g; 7.3% were full-term and 10.5% were small for gestational age. Eighty infants had umbilical artery catheters, of which 50% were placed below L4-5. There was no identifiable risk factor in 11.4%; in half of these infants, NEC developed during an epidemic. Clustering of cases occurred in seven of the 108 months studied. Cases during epidemics had a lower incidence of respiratory distress syndrome. Average age at onset of NEC was 12 days; however the most common agd (mode) was 3 days, and in 13.8% onset was after the third week. On the survivors, 4% had recurrent disease one to 20 days after reinitiation of enteric feeding. The occurrence of NEC in low-risk patients and in older neonates raises serious questions about the proposed pathogenesis of NEC.

Birth Weight↗
PubMed1990

Hemodynamic and permeability characteristics of acute experimental necrotizing enterocolitis.

We examined the local hemodynamic response of intestinal loops during acute necrotizing enterocolitis (NEC) in anesthetized rabbits. NEC was induced in ileal loops by transmural injection of a solution containing casein (10 mg/ml) and calcium gluconate (50 mg/ml) acidified to pH 4.0 with propionic or acetic acid. Control loops received casein only (pH 5.0). Mucosal damage was quantified by the blood-to-lumen movement of [51Cr]EDTA, fluid shifts into the lumen, and histology. Mean arterial pressure and loop blood flow were steady over the 3-hr period, loop fluid volume decreased, and there was no evidence of necrosis or epithelial damage. In loops receiving acidified casein and calcium gluconate, there was an immediate dramatic increase in loop blood flow that returned to baseline by 50 min. In addition, loop fluid volume was dramatically increased, necrosis was noted in the form of blunting and loss of villi, and sevenfold increase in [51Cr]EDTA permeability was evident. Administration of CV 1808 (30 mg/kg/hr), a selective adenosine2 agonist, which maintained and elevated loop blood flow throughout the 3 hr protocol, failed to alter the changes in loop fluid volume or prevent necrosis. Histamine levels in loop fluid levels were significantly elevated 20-30 min after NEC induction when compared to saline controls, indicating an early activation of mucosal defenses with this luminal insult. Thus, this model of NEC is characterized by a transient, acute hyperemia, increased intestinal permeability, and histamine release. As mucosal damage was independent of ischemia and could not be prevented by vasodilatory therapy, this model supports the clinical findings that NEC is correlated with luminal factors related to feeding and independent of cardiovascular stress.

Acid-Base Imbalance↗
PubMedDate not supplied

Neonatal necrotizing enterocolitis: experience with 100 consecutive surgical patients.

One hundred newborns with neonatal necrotizing enterocolitis (NEC) were treated surgically according to a uniform protocol between July, 1980 and June, 1988. The infants (53 females, 47 males) weighed between 600 and 3,800 g, averaging 1,500 g. Twenty-eight weighed less than or equal to 1,000 g, 38 weighed from 1,001 g to 1,500 g, and 34 weighed more than 1,500 g. Median age at the time of surgery was 14 days. Surgery was performed for pneumoperitoneum in 40, a "positive" paracentesis in 51, and for other reasons in 9 infants. A paracentesis was performed if intestinal gangrene was suspected clinically. Resection of gangrenous bowel with exteriorization was the usual procedure; in only 5 patients was primary closure performed. The hospital survival for the infants was 54% for the group weighing less than or equal to 1,000 g, 74% for the group weighing from 1,001 g to 1,500 g, and 79% for the group weighing more than 1,500 g. Overall hospital survival was 70%; it was 81% for those having a definitive procedure (excluding 14 infants with NEC "totalis"). There were 3 late deaths from causes unrelated to NEC. Significant long-term complications included failure-to-thrive in 23% and stricture formation in 30% of the survivors. Long-term follow-up showed gastrointestinal status to be normal in 74%; only 8% have persistent major gastrointestinal dysfunction. Mental and motor development was considered grossly normal in only 53% of the patients.

Birth Weight↗