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PubMed1981

The effect of intravenous amino acids on plasma amino acid concentration during total parenteral nutrition in infants with necrotizing enterocolitis.

Plasma aminograms of infants receiving total parenteral nutrition as part of the treatment for necrotizing enterocolitis were studied. Their ages varied from 2 to 60 days and their mean birth mass was 1 621 g (range 760-2 550 g). The intravenous administration of amino acids produced changes in plasma amino acid levels corresponding to the concentration of individual amino acid levels in the solution employed: higher levels of amino acids in the infusate produced increased plasma levels, whereas low plasma levels were obtained for amino acids not present or present in small amounts according to the solution used. The infants did not appear to suffer in any way, but the long-term effects still have to be evaluated. Pending further knowledge in this regard it is suggested that plasma amino acid levels should be maintained as near to normal values as possible. This could probably be achieved by the use of amino acid solutions specially formulated according to the amino acid profile of breast milk or the plasma amino acid profile of normal infants.

Amino Acids↗
PubMed1981

Severe Escherichia coli septicemia mimicking necrotizing enterocolitis.

Enteropathogenic and nonenteropathogenic strains of Escherichia coli have been impicated as causative agents in necrotizing enterocolitis (NEC). The case presented here illustrates an example of fulminant E coli infection in an infant who manifested signs and symptoms of NEC without developing bowel damage.

Diagnosis, Differential↗
PubMed1981

Neonatal necrotizing enterocolitis. Survival, management, and complications: a 25-year study.

One hundred sixteen infants with neonatal necrotizing enterocolitis (NEC) have been seen during a 25-year period (1955 through 1979). Prior to 1972, the survival rate was 17%; subsequently, it has been 68%. This increased survival is attributed to (1) improved physiologic care of the critically ill infant, (2) the institution of a standard management protocol, and (3) early diagnosis and treatment. Survival following neonatal NEC is attended by a significant incidence of intestinal stricture (21%); however, physical development has been normal and there have been few long-term gastrointestinal tract problems.

Birth Weight↗
PubMed1994

Necrotizing enterocolitis and infection.

Infections are considered to play an important role in the pathogenesis of necrotizing enterocolitis (NEC). The evidence for infectious causes of NEC is reexamined, with special attention to the clinical definition and reported outbreaks of NEC. Future areas of study are proposed.

Bacterial Infections↗
PubMed1996

[Risk and outcome factors in necrotizing enterocolitis].

OBJECTIVE: The objective of this study was to identify risk and outcome factors in necrotizing enterocolitis (NEC). PATIENTS AND METHODS: We have studied 72 cases of NEC collected from 1987 until 1994 in the three hospitals of the integrated Unit. A case-control study matched for gestational age and center was performed for 26 risk factors. Conditional logistic regression was used in significant bivariate variables. The 18 outcome factors had the same statical treatment, but without the paired design. RESULTS: Serous infections previous to NEC, apnea and feeding increments greater than 20 cc/kg/day have been identified as risk factors for preterm babies (p < 0.05). Severe acidosis and pneumoperitoneum have been found significant outcome variables, but with very low discriminatory capacity. CONCLUSIONS: It has been found difficult to identify risk factors for NEC besides the gestational age. Outcome factors have very low sensitivity. Preventive treatment should be directed to decrease the effect of the inflammatory mediators in the gastrointestinal tract.

Candida↗
PubMed1994

Neonatal necrotizing enterocolitis: a retrospective and multicentric review of 331 cases.

The authors retrospectively review 331 cases of necrotizing enterocolitis from 13 different departments of pediatric surgery; 184 cases were treated only medically at the acute stage (47 of whom developed intestinal stricture) and 147 cases were operated on at the acute stage. The different procedures of acute surgical intervention are reported and the results of two surgical procedures are compared. The first is a classical one comprising a laparotomy with exploration of the intestinal tract and resection of the necrotic segments followed by enterostomy above the resected area. The other procedure comprises a minimal laparotomy in the right lower quadrant with ileostomy above necrotic areas, without resection of necrotic segments associated with peritoneal drainage. The results are assessed using the postoperative mortality rate and the number of secondary intestinal strictures. Mortality during the first postoperative month occurred in 27.9% of cases, and intestinal strictures were noted in 31.3% of cases after acute surgical procedure.

Enterocolitis, Pseudomembranous↗
PubMed1991

Necrotizing enterocolitis following operation in the neonatal period.

Over a 16-year period, 33 newborn infants developed necrotizing enterocolitis (NEC) following some form of operation (accounting for 19 per cent of all neonates with NEC), including repair of myelomeningocele, intestinal atresia, gastroschisis and congenital diaphragmatic hernia. The neonates with postoperative NEC had a median birth-weight of 3.05 (range 1.0-4.4) kg, and median gestational age of 40 (range 27-41) weeks. Twenty patients were treated non-operatively. The remaining 13 required operation for complications of NEC. Twenty-three patients are alive and have been followed for a median of 66 (range 3-168) months. If a neonate deteriorates following any operation NEC must be included in the differential diagnosis.

Age Factors↗
PubMed1992

Contrast enema diagnosis of necrotizing enterocolitis.

Contrast enema was performed in a select group of 126 neonates with ambiguous diagnosis of necrotizing enterocolitis (NEC). Enema findings were compared with that on plain abdominal radiographs (AXR) and the clinical outcome. Thirty-one of the 34 patients with a discharge diagnosis of NEC were interpreted to have a positive contrast enema, and 91 of the 92 patients without a discharge diagnosis of NEC were interpreted to have a negative contrast enema. The AXR was interpreted as positive in 57 patients and as negative or indeterminate in 69. Not a single case of perforation was produced. Judicious use of contrast enema can improve specificity of diagnosis in cases with discordant clinical and plain radiographic findings.

Barium Sulfate↗
PubMed1991

Maternal cocaine abuse and necrotizing enterocolitis: outcome and survival.

Since 1987, multiple complications related to maternal cocaine abuse have been reported. Necrotizing enterocolitis-(NEC) of the newborn has been observed with increasing frequency. We report a comparative analysis of infants with NEC born to cocaine abusing mothers (n = 11) to a standard population of newborns with NEC (n = 50) treated in this institution from January 1987 to July 1989. We also evaluated whether prenatal cocaine abuse predisposes infants to NEC by performing a case-control analysis using 51 of 61 infants and controls matched for race, sex, and birthweight +/- 250g. Significant differences were apparent between the cocaine-affected infants (COC) and the noncocaine-affected infants (Non-COC) with regard to surgical intervention (72.7% v 38%, P less than .05), the presence of massive gangrene (54% v 12%, P less than .01), mortality (54.5% v 18%, P less than .01), and maternal age (28.13 +/- 3.82 years v 24.12 +/- 6.21 years P less than .05). No differences between these groups could be demonstrated for other known NEC risk factors such as gestational age, birthweight, feeding patterns, umbilical artery catheters, or asphyxia. In the matched case-control study, infants born to mothers who were cocaine abusers demonstrated a 2.5-fold increased risk of developing NEC (95% Cl = 1.17 to 5.32, P = .02) when compared with the noncocaine-exposed group. Maternal cocaine abuse appears to play a contributory role in the pathogenesis of NEC, its extent, and its outcome.

Adult↗
PubMed1994

Plasma interleukin-6 and tumour necrosis factor levels as predictors of disease severity and outcome in necrotizing enterocolitis.

Plasma tumour necrosis factor (TNF) and interleukin-6 (IL-6) levels of 18 infants with necrotizing enterocolitis (NEC) were measured at the time of diagnosis or on transfer to a paediatric surgical unit. Whereas TNF levels were similar for infants managed medically (stage II, n = 8) and surgically (stage III, n = 7), IL-6 levels were significantly higher in stage III cases (mean, 3,127 pg/mL [95% CI, 1,809 to 4,445 pg/mL]) than in stage II (mean, 127 pg/mL [95% CI, 10 to 329 pg/mL]; P = .001). Neither TNF nor IL-6 level predicted eventual outcome. Plasma IL-6 may be useful as an indication for operation in NEC.

Biomarkers↗
PubMed1995

An intraluminal model of necrotizing enterocolitis in the developing neonatal piglet.

UNLABELLED: The most common risk factors for the development of necrotizing enterocolitis (NEC) are prematurity and enteral feeding. Most models of NEC involve ischemic insult resulting in generalized necrosis, different from the classical ileocecal predilection of NEC. This anatomic predisposition is explained by dysmotility of immature gut, leading to bacterial overgrowth in the terminal ileum and colon. Infant formula containing lactose as the sole carbohydrate source overwhelms partially developed lactase activity, allowing enteric bacteria to ferment excess carbohydrate to short-chain fatty acids, decreasing intraluminal gut pH and predisposing to mucosal injury. Impaired clearance of intraluminal contents exacerbates this effect. In the present study the authors used a model of NEC, originally developed in rabbits and based on analysis of intestinal contents of NEC babies, modified and adapted here to neonatal piglets, the gastrointestinal tract of which more closely resembles the human neonate. METHOD: Piglets < 3 days old and 2 weeks old were laparotomized. Loops created from the distal ileum to the proximal colon were injected with isoosmolar acidified casein solution or 0.9% saline. Segments were harvested 3 hours later, sectioned for H&E, and graded from 0 (intact villi) to 4 (transmural necrosis). RESULTS: Acidified casein-induced damage included areas of necrosis, submucosal edema, inflammatory cell infiltrate, and lymphatic distension. In younger animals, lesions were more pronounced (3.25 +/- 0.13 for the < 3-day-old v 2.43 +/- 0.14 for the 2-week-old piglets; P < .005). CONCLUSION: The authors believe that this piglet NEC model most closely approximates human NEC because it incorporates two of the most common risk factors: dysmotility (by creating intestinal loops) and enteral feeding (by intraluminal injection of acidified casein).

Aging↗
PubMed1992

Treatment for necrotizing enterocolitis perforation in the extremely premature infant (weighing less than 1,000 g).

The frequency of necrotizing enterocolitis (NEC) in the extremely premature infant (less than 1,000 g) is still high and it is very difficult for infants weighing less than 1,000 g with NEC perforation to survive. In our institutes, the management protocol for NEC perforation in infants weighing less than 1,000 g includes peritoneal drainage under local anesthesia, administration of coagulating factor XIII, and the usual treatment for septic shock. During the past 3 years, four infants weighing less than 1,000 g with NEC perforation have survived using this protocol without laparotomy. This management protocol is the treatment of choice in infants in very poor condition or infants weighing less than 1,000 g with NEC perforation.

Diseases in Twins↗
PubMed1988

Peritoneal drainage for necrotizing enterocolitis.

This study evaluates the role of primary peritoneal drainage (PPD) in the management of neonatal necrotizing enterocolitis (NEC). Of 169 patients with definite NEC, 92 (55%) underwent operation: primary laparotomy, 41 patients (45%); and PPD, 51 patients (55%). Seventeen (33%) of the PPD infants had subsequent laparotomy within seven days. Pneumoperitoneum was the indication for operation in 37% of the primary laparotomy and 67% of the PPD infants. Following PPD, 34 patients (67%) showed clinical improvement. Operative survivals were as follows: primary laparotomy, 83%; PPD, 53%. Infants who had PPD had a significantly lower mean birth weight, gestational age, preoperative pH and platelet count, and a significantly higher incidence of intraventricular hemorrhage and patent ductus arteriosus. For infants weighing less than 1,000 g at birth, the survival was similar following primary laparotomy (57%) and PPD (52%); this occurred in spite of the higher incidence of adverse risk factors in the PPD infants. For infants weighing greater than 1,000 g, the survival was 86% following primary laparotomy and 62% after PPD; in this group, all the early deaths following PPD occurred in critically ill infants who died within 48 hours of drainage. The late survival rates were as follows: primary laparotomy, 76%; PPD, 35%. More than half of the late deaths following PPD were not related to NEC, reflecting the difference between the two patient populations. Primary peritoneal drainage is a useful adjunct to resuscitation of the critically ill infant with complicated NEC, particularly prematures less than 1,000 g birth weight with intestinal perforation. Primary peritoneal drainage is not an alternative to laparotomy, which is recommended when an optimal clinical response has been achieved.

Drainage↗
PubMed1988

Surgical treatment of necrotizing enterocolitis: a population-based study in the Grampian region, Scotland.

Ninety-two cases of necrotizing enterocolitis (NEC) were diagnosed in the Grampian Region of Scotland between 1978 and 1984, for a regional incidence of 2.2/1,000 live births. Twenty-seven cases (29.3%) required surgery, 19 acutely and eight for delayed stricture. Acute operative mortality was 10.5%. Disease-related mortality was 3.3%, and overall mortality was 8.7%. Follow-up ranged from 15 to 77 months for surgical patients, with only three of 23 survivors having increased bowel frequency.

Enterocolitis, Pseudomembranous↗
PubMed1996

Enteric fistulas and necrotizing enterocolitis.

The incidence, presentation, significance, and outcome of infants with internal enteric fistula formation secondary to necrotizing enterocolitis (NEC) were examined. Of 130 infants with NEC treated during a 7-year period, an enteric fistula developed in five (4%). The gestational age of these patients (3 boys, 2 girls) ranged from 25 to 40 weeks and their birth weight ranged from 800 to 3,460 g. Two had Down's syndrome. Plain abdominal radiographs showed widespread intramural gas in all, and portal vein gas in two. Four patients required early laparotomy, which confirmed extensive intestinal necrosis; a diverting jejunostomy or ileostomy was constructed in three, and the abdomen was closed with drainage in one. Fistulas were diagnosed by contrast radiology between 16 and 51 days after the onset of NEC, and were jejunocolic (2), ileocolic (2), and colocolic (1). They were associated with enteric stricture(s), an inflammatory mass, and clinical signs of intermittent sepsis. One infant with an ileocolic fistula died of sepsis before definitive surgical treatment. Of the four who underwent surgery, two survived after limited intestinal resection, but one of the two with short bowel syndrome died. Enteric fistula formation is a rare complication of NEC. Typically it occurs with colonic stricture(s) and is associated with signs of incomplete bowel obstruction and intermittent sepsis. Resectional surgery is successful, but there appears to be a significant risk of short bowel syndrome.

Birth Weight↗
PubMed1997

Survival after necrotizing enterocolitis in infants weighing less than 1,000 g: 25 years' experience at a single institution.

Necrotizing enterocolitis (NEC) primarily affects premature newborns. Regional and national decreases in the mean birthweight and gestational age of neonatal intensive care unit (NICU) admissions prompted a review of NEC in VLBW (very low birth weight, defined as < 1,000 g) infants in our institution over a 25-year period. There were 266 patients treated for NEC during the study interval. We compared 71 VLBW with 195 non-VLBW infants and found that VLBW infants were: fed later (6.4 days v 4.1 days, P = .009), developed NEC later (20.8 days v 13.1 days, P = .002), had significantly lower 1- and 5-minute Apgar scores, were more likely to require surgery (51% v 34%, P = .016), more often had panintestinal (defined as > 75% of intestinal length) involvement (10% v 4%, P = .043), and had poorer survival (56% v 72%, P = .013). Overall survival after NEC has improved over the study interval, both in our series and in other reports. However, the increasing number of VLBW infants who have NEC represent a subgroup who appear to be generally more ill, develop NEC later, require surgery with greater frequency than their non-VLBW counterparts, and are less likely to survive.

Age of Onset↗
PubMed1990

Prenatal and postnatal corticosteroid therapy to prevent neonatal necrotizing enterocolitis: a controlled trial.

To determine whether prenatal corticosteroid therapy would reduce the incidence of neonatal necrotizing enterocolitis (NEC), we assigned a total of 466 women admitted in premature labor either to receive placebo (group A, n = 256), if delivery was expected to occur within 24 hours of admission, or to receive betamethasone (group B, n = 210) if delivery was expected to take place more than 24 hours after admission. All women were free of severe medical complications or drug therapy; cases of intrauterine growth retardation or premature rupture of the membranes were excluded. Their newborn infants, excluding malformed, congenitally infected, and growth-retarded infants, were enrolled in the study unless they had died before the age of 10 postnatal days. Babies born to group A mothers (n = 248) were further assigned to a treatment group (group A1, n = 130) receiving dexamethasone, 2 mg/kg/day by intravenous injection during the first 7 days of life, or to a control group (group A2, n = 118) receiving 10% dextrose solution placebo. Group B infants (prenatal betamethasone, n = 205) received neither treatment nor placebo. The incidence of NEC in group A1 was 6.9% (9/130), and in group A2 it was 14.4% (17/118) (p less than 0.05). In group B the incidence was 3.4% (7/205); this was much lower than in group A2 (p less than 0.01) and lower than in group A combined (10.4%) (p less than 0.01). There was no death from NEC and no surgical intervention among group B patients. The mortality rate for group A1 (11%) was lower than for group A2 (56%) (p less than 0.02). There were fewer indications for surgical intervention for NEC in group A1 than in group A2. Histologic studies confirmed bowel ischemia in all specimens analyzed. These data support the hypothesis that the incidence of NEC is significantly reduced after prenatal steroid treatment. Although postnatal therapy with steroids does not decrease the incidence as effectively as prenatal therapy, it improves clinical outcome of NEC.

Adult↗
PubMed1993

Necrotizing enterocolitis (NEC)--mortality and long-term results.

From 1974-88 73 patients were treated for necrotizing enterocolitis (NEC) in the surgical department at the Children's Hospital of Cologne. 70% of these had other complaints and 77% were premature babies, of which 30% were small-for-dates. A greater than expected proportion of deaths occurred in babies not of low birth-weight: Of those above 2500 g 35% died and of those under 1500 g 20%. Initial signs and symptoms became apparent in 80% within the first two weeks. The most frequent signs were distended abdomen (81%), diffuse tenderness (46%), bloody stools (39%) and absent peristalsis (39%). Radiology showed edema of the bowel wall in 49%, free air in the abdomen in 38% and intestinal pneumatosis in 34%. It remains questionable whether peritoneal lavage could lead to earlier diagnosis and referral of the sick children to the hospital. The course of the disease was less severe when babies had received breast milk. Colon and distal ileum were involved most frequently. Laparotomy showed perforations of the bowel in 39 patients (64%), inflammatory alterations in 18 and necroses in 12. The survival rates improved within the period of 1974-88 from 64 to 79%. Thirty-two of the 51 survivors were available for follow-up: 9 patients (28%) had more than 4 stools/day, 8 (25%) were underweight, 8 (25%) suffered from food intolerance, 5 (16%) from diarrhoea, 4 (13%) from limited exercise tolerance. Physical retardation could only be seen in 3 children under the age of 2.

Birth Weight↗