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PubMed1979

Changing patterns of neonatal necrotizing enterocolitis.

In a 4 year and 4 month period 80 patients with necrotizing enterocolitis were treated. Review of the mode of clinical presentation, radiological features, management, mortality, and complications showed that there have been considerable changes over this period. The disease is now frequently diagnosed clinically prior to the development of paralytic ileus. Scalloping of the bowel wall and separation of the bowel loops are probably the earliest radiological signs. The management has become a more aggressive medical approach with more limited and well-defined surgical indications. These changes have been associated with a marked decrease in mortality and a concomitant increase in the number of late complications.

Enterocolitis, Pseudomembranous↗
PubMed1994

Necrotizing enterocolitis: laboratory indicators of surgical disease.

The timely distinction between infants with necrotizing enterocolitis (NEC) who need surgery and those who are likely to recover with medical management is important, but it may be difficult clinically. Because pneumoperitoneum is not always present, additional markers of bowel gangrene are needed. Among 73 babies managed for NEC over the study period, 49 (67%) met the study criteria of Bell's stage > 1, and their records were reviewed to determine the usefulness of common laboratory tests in predicting outcome. The patients were divided into three groups based on management. Group 1 (7 patients) required surgery at the time of initial presentation because of pneumoperitoneum. The remaining 42 patients were initially managed medically, 19 of whom (group 2) recovered successfully; the other 23 (group 3) required surgery. The combination of certain laboratory tests, ie, white blood cell count (WBC), immature:total neutrophil ratio (I:T), platelet count (PLT), and base excess (BE), was of significance in distinguishing between infants who would need surgery and those who would recover with medical therapy (group 3 v group 2) 4 to 12 hours or 12 to 24 hours after the diagnosis of NEC was established. A scoring scale was developed, with a point for each of the following: WBC < 9,000/mm3, I:T > .5, PLT < 200,000/mm3, and BE < or = -2. A score of > or = 3 during 4 to 12 hours after diagnosis of NEC strongly predicted the presence of surgical disease (positive predictive value, 100%; negative predictive value, 76%; specificity, 100%; sensitivity, 64%).(ABSTRACT TRUNCATED AT 250 WORDS)

Enterocolitis, Pseudomembranous↗
PubMed1981

Intestinal stricture after necrotizing enterocolitis.

Between 1974 and 1979 inclusive, 20 of 175 neonates with previous necrotizing enterocolitis (NEC) developed obstruction from intestinal stricture 1-20 mo after the diagnosis of NEC. Seven were found in the small bowel, 19 in the colon. Treatment included proximal decompressive enterostomy with subsequent resection in 6 and primary resection in 11. Two died during attempts to restore GI continuity and one died from cardiac disease before any GI surgery. Morbidity occurred in six. Various stages of wound healing from acute inflammation to dense fibrosis were found in pathologic specimens. Fibrosis was most marked in the submucosa and most consistently found in specimens resected 3 mo after the acute episode of NEC. Intestinal stricture develops in 6%-33% of the infants with previous NEC. Eighty percent of these strictures are colonic, 30% are left sided, and 15% are multiple. Multiple lesions are exclusively colonic. Histology varies with age of lesion. The predominant feature of stricture is submucosal fibrosis. Strictures less than 3 mo old still have acute inflammatory disease, older strictures are mature and fibrotic. The best diagnostic tools are a high index of suspicion and a barium enema. An intestinal stricture should be suspected in any infant with a past history of NEC and: (1) symptoms of obstruction or failure to thrive; (2) previous exteriorization or proximal diversion of acute or chronic NEC lesions; or (3) peritoneal drainage under local anesthesia for NEC perforation. Treatment should be tailored to the infant's condition and the time elapsed since the acute NEC episode. Resection of the stricture must be complete otherwise recurrence or leak is unlikely. Intestinal diversion with a 3-6-mo delay before reconstruction appears safer in the child with little margin for error. Earlier restoration of blood flow and cessation of intestinal function during the acute episode of NEC might reduce the incidence of stricture.

Colonic Diseases↗
PubMed1981

Prospective evaluation of radionuclide scanning in detection of intestinal necrosis in neonatal necrotizing enterocolitis.

The ability of external imaging to demonstrate intestinal infarction in neonatal necrotizing enterocolitis (NEC) was prospectively evaluated. The radiopharmaceutical technetium--99m diphosphonate was injected intravenously and the patients subsequently underwent abdominal scanning. Clinical patient care and interpretation of the images were entirely independent throughout the study. Of 33 studies, 7 were positive, 4 were suspicious, and 22 were negative. One false positive study detected ischemia without transmural infarction. The second false positive scan occurred postoperatively and was due to misinterpretation of the hyperactivity along the surgical incision. None of the suspicious cases had damaged bowel. The two false negative studies clearly failed to demonstrate frank intestinal necrosis. The presence of very small areas of infarction, errors in technical settings, subjective interpretation of scans and delayed clearance of the radionuclide in a critically ill neonate may all limit the accuracy of external abdominal scanning. However, in spite of an error rate of 12%, it is likely that this technique will enhance the present clinical, laboratory, and radiologic parameters of patient management in NEC.

Clinical Trials as Topic↗
PubMed1987

The role of intraluminal tension and pH in the development of necrotizing enterocolitis: an animal model.

Presented is an in vivo animal model of necrotizing enterocolitis (NEC) in which we used an isolated loop of rabbit colon. Changes in mucosal perfusion and macroscopic and microscopic appearances were studied after exposure of the mucosa to different intraluminal tensions and pHs. Mucosal perfusion was reduced with increasing intraluminal tension and decreasing pH. Histologic changes consistent with NEC were identified after five hours when the mucosa had been exposed to both increased intraluminal tension and decreased pH. Factors affecting intraluminal tension and pH could influence the development of NEC in the neonate.

Animals↗
PubMed1987

Early ileostomy closure in necrotizing enterocolitis.

The nutritional and metabolic complications following intestinal resection and ileostomy for necrotizing enterocolitis (NEC) in low birth weight preterm infants often necessitate repeated prolonged hospitalization for salt and water imbalance and reliance on total parentaral nutrition (TPN). The traditional concerns about anesthetic and anastomotic complications delays the restoration of intestinal continuity until the infant has attained a weight of about 5 kg, but recent nutritional balance studies in our unit have shown a combination of nutrient and mineral malabsorption in neonates with ileostomies. Beginning 4 years ago, a prospective study of early closure of the ileostomy was undertaken in infants weighing as low as 2 kg to examine the effect on surgical morbidity, infant growth, and gastrointestinal function using the preclosure infant as his/her own control. Ten infants with birthweights ranging from 670 to 2,000 g developed NEC requiring ileostomy at age three days to 11 weeks. In addition to partial ileal resection, the cecum was resected in 10 patients, ascending colin in 7, transverse in 4, descending colon in 1 patient. Postoperative treatment, including short-term TPN and elemental diet, preceded closure of ileostomy at a mean age of 18 weeks (range 5 to 36 weeks). Mean weight at time of closure was 3,052 +/- 994 g. There were no short-term complications of early closure in this series, nor was there any incidence of anastomotic dysfunction, colon stricture, or recurrent NEC.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1982

Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants. Absence of identifiable risk factors.

Necrotizing enterocolitis has been associated with a variety of perinatal problems which have been purported to be risk factors predisposing the neonate to NEC. The present investigation compares the perinatal histories of 48 low-birth-weight infants (less than 1,500 gm) with NEC to those of 553 high-risk infants of equivalent birth weight who did not have NEC but who were present in the nursery during a four-year observation period. The two populations were equivalent with regard to maternal factors such as socioeconomic status, education, race, and age. Both the antenatal and intrapartum risk scores were similar, as were the position of presentation and mode of delivery. The incidence of pre-eclampsia, prolonged rupture of the membranes, and placenta previa was also equivalent. Birth weight and gestational age were identical, as well as intrauterine growth retardation and low Apgar scores. The placement of umbilical artery catheters or the performance of exchange transfusions were not more frequent among patients with NEC. Infants who developed NEC demonstrated significantly different incidences of only three variables. Mothers of these infants were usually married, and their infants had less respiratory distress syndrome; the only adverse factor present more frequently was abruptio placenta. These data raise further questions concerning the significance of previously reported risk factors of NEC.

Adult↗
PubMed1989

Factors associated with age of onset of necrotizing enterocolitis.

To investigate factors associated with risk and age of onset for necrotizing enterocolitis (NEC), a retrospective case-control review was performed of patients with NEC and control infants matched for birthweight and date of admission. NEC cases were defined by Bell staging criteria and were included if pneumatosis intestinalis, histologic confirmation, or a recognized complication of NEC was identified in association with clinical signs and symptoms. NEC was significantly related to birthweight and premature post-conceptional age. In contrast to control infants, patients with NEC had higher 5 minute Apgar scores, less significant respiratory disease, and more rapid feeding practices. Two distinct subgroups of patients with NEC based on postnatal age of onset were apparent. Patients with early onset NEC (21 days or less postnatal age) had less significant respiratory disease and were fed more rapidly than late onset patients. Late onset NEC (more than 21 days postnatal age) occurred frequently in convalescing, relatively well premature infants who were still, however, of preterm postconceptional age. Relatively well premature infants with minimal respiratory disease are still at risk for NEC. Advances in neonatal care and survival of very low birthweight infants may account for a shift in prevalence to older infants who are yet of preterm postconceptional age.

Age Factors↗
PubMed1998

Morphologic alterations of the enteric nervous system and deficiency of non-adrenergic non-cholinergic inhibitory innervation in neonatal necrotizing enterocolitis.

Although damage to intramural nervous tissue should be expected in neonatal necrotizing enterocolitis (NNEC), as the pathology of NNEC is defined by substantial destruction of the bowel wall, only a few studies have considered its implication. Thus, the aim of the study has been to examine morphological alterations of the enteric nervous system (ENS) in intestinal segments affected by NNEC. Immunohistochemical methods allowed the demonstration of both neuronal and glial elements and the assessment of an altered localization of non-adrenergic non-cholinergic (NANC) inhibitory mediators within the intramural plexuses. Intestinal segments from patients with NNEC (n = 8) and control subjects (n = 3) were obtained and submitted to immunohistochemical examination incubating with antibodies against protein gene product (PGP) 9.5, protein S-100, vasoactive intestinal polypeptide (VIP) and nitric oxide synthase (NOS). The most severe damage of nervous tissue was found within the plexus mucosus and plexus submucosus internus. The ganglionated plexuses showed a loss ot both glial and nerve cells with various stages of cell deterioration and the formation of central lesions within the myenteric ganglia. The observed neuropathologic changes correspond to the group of acquired segmental hypoganglionosis. Specimens from patients with NNEC were also characterized by an absence of immunoreactive VIP and NOS in the plexus submucosus and within the circular muscle layer. The deficiency in NANC inhibitory innervation may contribute to the formation of functional obstructions following acute NNEC. Furthermore, it is likely that the neuropathological lesions induced in early stages of NNEC may result in dysfunctional intestinal motility facilitating intraluminal bacterial overgrowth and translocation, and therefore, possibly promote the self-perpetuating pathophysiologic cycle culminating in progressive NNEC. As an additional finding, two patients with NNEC showed typical features of intestinal neuronal dysplasia (IND). The association of NNEC and IND is reviewed in the literature and possible causalties are discussed.

Enterocolitis, Pseudomembranous↗
PubMed1992

Necrotizing enterocolitis in a perinatal centre.

Thirty-five neonates developed radiologically proven necrotizing enterocolitis (NEC) over a 40 month period. They were 28 +/- 2 weeks gestation, and weighted 1094 +/- 411 g at birth. Eighteen infants (51%) required surgery and three (8.5%) died. The incidence was 6.7% in the very low birthweight (VLBW) infants. A large proportion of NEC (60%) presented beyond 10 days of life. An inverse relationship between gestation and age of onset was observed. The age of presentation was 22 +/- 13 days (range 10-53 days) for the 18 infants less than or equal to 28 weeks compared with 7 +/- 5 days for those over 28 weeks (P less than 0.01). Five NEC infants had bacteraemia which occurred 2-7 days prior to gastrointestinal symptoms of NEC, and four were staphylococcal. Compared with infants controlled for gestation, there was no significant differences observed in perinatal events or feeding history. We concluded that an immature gastrointestinal system is vulnerable to NEC even beyond the early neonatal period.

Enterocolitis, Pseudomembranous↗
PubMed1979

Necrotizing enterocolitis of infancy. Early roentgen patterns as a guide to prompt diagnosis.

Necrotizing enterocolitis of infancy most commonly affects premature infants during the first several weeks of life. In most cases it is a devastating condition that often progresses to severe complications of death. The classic abnormalities, such as gas in the bowel wall and/or portal vein, are generally late manifestations. The author has consistently observed several distinct radiographic findings in early stages of the disease: (a) ileus and elongation of bowel loops; (b) loss of bowel wall definition; and (c) a disorganized, atonic pattern of intestinal gas. These findings are helpful in early diagnosis, particularly when the clinical features are nondiagnostic.

Enterocolitis, Pseudomembranous↗
PubMed1991

[Investigation on high risk factors of neonatal necrotizing enterocolitis].

In order to evaluate the factors in high-risk neonatal necrotizing enterocolitis (NEC) and predict the prognosis of NEC, a retrospective analysis of 32 factors was made in 42 neonates with NEC. The cases were divided into a low-risk (survival) group and a high-risk (death) group. Of 32 factors compared between these two group, eight were found to be of significance in evaluating the severity of NEC, and six of them were used in the development of a NEC scores (1) number of days before beginning of artificial feeding; (2) neonatal asphyxia or distress; (3) immature form in WBC differential; (4) CO2 combining power; (5) abdominal tenderness; (6) presence of portal vein air (PVA). All laboratory values and physical and radiographic signs were collected during initial presentation of NEC. Neonates with a score of 3 or more are at an increased risk of developing severe NEC with a 83% mortality.

China↗
PubMed1982

[Role of maturation in the occurrence of necrotizing enterocolitis].

Over a 3 years and an half period, 40 cases of necrotizing enterocolitis (NEC) are diagnosed in a neonate unit. This represents, 1,22% of total admissions. A new notion is found out: the âge at the onset of NEC is viewed as the post-conceptional age (post-natal age added to gestational age). The cut-off period takes place at 34-36 weeks of post-conceptional age. The low birth weight newborn infants (less than 1 500 g) are significantly more concerned than the others, respectively 5,8% (13/222) and 0,8% (27/3 056). However, the inverse and significant correlation between the delay of onset of NEC and the birth weight is weak. The additional impact of feeding and blood transfusions on the role played by maturation is examined.

Age Factors↗
PubMedDate not supplied

[Human colostrum in the prevention of diarrhea and necrotizing enterocolitis].

The effect of human colostrum in the prevention of diarrhea and necrotizing enterocolitis, as well as the advantages of its use in gastroenteritis, was studied in 71 premature newborns. The frequency of diarrhea and enterocolitis in 16 healthy newborns who were given human colostrum (group II), was less than in the 22 healthy newborns who received only cows milk (group I), but without statistical significance. In 25 infants with diarrhea who were given human colostrum, the frequency of enterocolitis and sepsis (group IV) was less than in the 8 infants with diarrhea who didn't receive human colostrum (group III). At the end we suggest that human colostrum should be given in high risk infants in order to decrease the frequency of diarrhea and enterocolitis and we also make some recommendation as to how to obtain and store human colostrum.

Biological Products↗
PubMed1994

Follow-up for infants with necrotizing enterocolitis.

Following discharge from the hospital, many infants who have survived acute necrotizing enterocolitis (NEC) remain at significant risk for continuing morbidity. Follow-up care of these infants is increasingly becoming the responsibility of the primary care physician. This article reviews the more common long-term medical and neurodevelopmental sequelae identified in NEC survivors and presents a practical approach to the clinical follow-up of these infants.

Child Development↗
PubMed1977

Protection against experimental necrotizing enterocolitis by maternal milk. I. Role of milk leukocytes.

A rat model of necrotizing enterocolitis of the neonate in which maternal milk had been protective was studied to determine what components of the milk afforded protection and by what mechanism. Frozen and thrawed rat milk was not protective, but formula supplemented with rat milk cells was. It was concluded that the cells provided protection. The cells, which are principally mononuclear phagocytes, can phagocytize and kill the Klebsiella pneumoniae strain used in the animal model. Animals with necrotizing enterolitis had peritonitis and bacteremia caused by this bacillus.

Animals↗
PubMed1978

Necrotizing enterocolitis in acute leukemia: radiographic findings.

Acute gangrenous appendicitis or right lower quadrant necrotizing enterocolitis occurs with a high incidence in patients undergoing treatment for acute leukemia. In a series of 81 fully documented cases with complete charts and follow-up we identified seven surgically or pathologically proved cases of this syndrome. Plain radiographs of the abdomen were available in five of the seven cases, and a barium enema was performed on one. In three of the five cases the radiographic examination suggested or confirmed the nature of the right lower quadrant syndrome. Two of the seven patients were sucessfully treated by appropriate surgery. The radiographic findings in this series are reviewed and re-emphasized since an accurate diagnosis becomes important in appropriate management of this formerly uniformly fatal complication of acute leukemia and/or its therapy.

Acute Disease↗