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At least 19 recordsLinked to original sources
PubMed1976

Changing clinical and roentgenographic patterns of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) occasionally deviates from the classical presentation of the disease. Small bowel dilatation and pneumatosis are frequently present prior to the actual onset of the clinical presentation. Pneumatosis intestinalis, an important diagnostic sign of NEC, is quite variable; it may be present, persist, worsen, or disappear; or at times it may not be present at all. A severe complication of necrotizing enterocolitis is perforation which in 50 percent of the cases presented without obvious free intra-abdominal air. Accumulation of fluid in the abdomen is stressed as strong evidence for perforation and a strong indication for surgery. The varying features indicate that NEC has a clinical spectrum that extends from benign to severe, and recognition of all these variations will lead to better diagnosis and to a better understanding of the disease. The clinical and roentgenologic variations make classification difficult but the variety most likely represents the combination of a great number of susceptible children and a greater recognition of the disease.

Air↗
PubMed1977

[Necrotizing enterocolitis (pediatric review)].

Necrotizing enterocolitis--a highly letal disease in the newborn period--is diagnosed in about 1--2% of the admissions to a nursery. The marcroscopic lesions are basically necroses predominantly found in the ileum, colon and jejunum. Untreated they lead to perforation, peritonitis and sepsis. The predisposing factors include such as perinatal complications, immaturity and umbilical vein catheterization; the main symptoms are bile stained vomiting and blood-streaked diarrhea, followed by signs of fulminant sepsis and peritonitis. The most typical roentgenographic findings are intramural air (pneumatosis intestinalis) and in more advanced cases pneumoperitoneum (free peritoneal air) and portal vein gas. The current plan of management--consisting of immediate withdrawal of oral feeds, gastric suction, intravenous fluid therapy, treatment of shock and administration of antibiotics--and the indication for operation are discussed. Perinatal stress and secondary bacterial invasion of the intestinal lesions seem to play an important role in the etiology of the disease. An early nutrition of the healthy immature with human breast milk seems to reduce the incidence of necrotizing enterocolitis or at least has a mitigating influence on the later course of the disease. The mortality in our own series--as reported--was high (6 patients: 1 survivor, mortality: 83%) as 4 of the patients were admitted with gross symptoms of intestinal perforation and severely shocked.

Disseminated Intravascular Coagulation↗
PubMed1979

Necrotizing enterocolitis in the neonate.

Necrotizing enterocolitis has become the most common condition requiring emergency surgical treatment in the newborn infant, far surpassing all major congenital anomalies in number of presentations and in deaths after surgical treatment. No single cause for the disease is known. Necrotizing enterocolitis is characterized by ischemic necrosis of the intestine, with minimal inflammation. In 25 of 50 per cent of patients, surgical resection of gangrenous bowel is necessary. Operation is reserved for infants with intestinal perforation or grangrene. Recent refinements of indications for operation often permit surgical intervention to coincide with the advent of intestinal gangrene. At operation, expeditious resection of frankly necrotic bowel and exteriorization of the marginally viable ends is all that should be attempted. Special problems postoperatively consist of management of sepsis, maintenance of nutrition and vigilant observation for early and late complications, particularly the development of ischemic intestinal stricture.

Animals↗
PubMed1979

Surgical experience with neonatal necrotizing enterocolitis (NNE).

Neonatal necrotizing enterocolitis, a highly lethal disorder of premature infants, is a common occurrence in newborn care units. This report details operative experience with 33 infants over the past seven years. During this time many more infants with NNE have recovered with supportive therapy. All patients are treated on a standard protocol of therapy and monitoring designed to select those with signs of continuing clinical deterioration. Therefore, those coming to operation had additional complications, such as perforation, intestinal gangrene or stenosis. This protocol is described. The 33 infants, averaging less than 4 lbs., developed NNE within five days of birth. Perforation and signs of continued clinical deterioration were the indications for operation; severe sepsis and clotting abnormalities were the rule. The overall mortality was 40% but included six infants with total bowel necrosis who had laparotomy alone. Five patients had intestinal or colonic resection with primary anastomosis, with two leaks leading to death. Twenty-one patients had staged resection with delayed anastomosis and only four deaths. Thus 27 determinative cases had a 26% mortality, and the recent group with staged resection had a 19% mortality. The essentials of pre-, intra- and postoperative management are detailed, as well as pathology and bacteriologic data. Most infants had temporary malabsorption requiring parenteral nutrition and special diets. Long-term results are gratifying.

Enterocolitis, Pseudomembranous↗
PubMed1978

Preventing necrotizing enterocolitis in neonates.

Necrotizing enterocolitis of newborn infants virtually vanished from our nurseries during the four years since the introduction of a slowly progressive feeding regimen. This cautions approach to feeding has been applied to selected infants whose condition during labor and delivery or whose neonatal problems indicate that they are at risk.

Enteral Nutrition↗
PubMed1979

Neonatal necrotizing enterocolitis: review and current concepts.

Necrotizing enterocolitis poses a serious threat to the increasing number of "at risk" neonates. Its clinical picture is characterized by abdominal distension, gastric retention, bile vomitus, and bloody stools. Abdominal roentgenograms demonstrate loops of intestine with intramural gas. Many of the neonates with necrotizing enterocolitis have been successfully managed by aggressive medical treatment. A review of the clinical course of 64 neonates with necrotizing enterocolitis in the acute phase suggests that either persistence of abdominal distention, development of edema and erythema of the abdominal wall, or pneumoperitoneum are indications for surgical intervention. Seven neonates presented with colonic stenosis several months after the management of the acute phase of necrotizing entercolitis.

Constriction, Pathologic↗
PubMed2025

Characterization of gut microbiota signatures in Indian preterm infants with necrotizing enterocolitis: a shotgun metagenomic approach.

INTRODUCTION: Necrotizing enterocolitis (NEC) is an inflammatory bowel disease that primarily affects preterm infants. Predisposing risk factors for NEC include prematurity, formula feeding, anemia, and sepsis. To date, no studies have investigated the gut microbiota of preterm infants with NEC in India. METHOD: In the current study, shotgun metagenomic sequencing was performed on fecal samples from premature infants with NEC and healthy preterm infants (n = 24). Sequencing was conducted using the NovaSeq X Plus platform, generating 2 &#xd7; 150 bp paired-end reads. The infants were matched based on gestational age and postnatal age. RESULT: The median time to NEC diagnosis was 9 days (range: 1-30 days). Taxonomic analysis revealed a high prevalence of Enterobacteriaceae at the family level, with the genera Klebsiella and Escherichia particularly prominent in neonates with NEC. No statistically significant differences in alpha or beta diversity were observed between stool samples from infants with and without NEC. Linear regression analysis demonstrated that Enterobacteriaceae were significantly more abundant in stool samples from infants with NEC than without NEC (q < 0.05). Differential abundance analysis using Linear Discriminant Analysis Effect Size (LEfSe) identified Klebsiella pneumoniae and Escherichia coli as enriched in the gut microbiota of preterm infants with NEC. Functional analysis revealed an increase in genes associated with lipopolysaccharide (LPS) O-antigen, the type IV secretion system (T4SS), the L-rhamnose pathway, quorum sensing, and iron transporters, including ABC transporters, in stool samples from infants with NEC. CONCLUSION: The high prevalence of Enterobacteriaceae and enrichment of LPS O-antigen and T4SS genes may be associated with NEC in Indian preterm infants.

Humans↗
PubMed1979

Asymptomatic cecal stenosis after necrotizing enterocolitis.

Survival of infants with necrotizing enterocolitis may be complicated by intestinal stricture(s) as a result of healing of ischemic segments of bowel. An asymptomatic cecal stenosis not visible on barium enema was identified at operation for reestablishment of intestinal continuity. Infants recovering from acute necrotizing enterocolitis deserve continued surveillance for mechanical and functional abnormalities of the gastrointestinal tract. Patency of the intestinal lumen distal to the ostomy site should be clearly demonstrated by the surgeon when continuity is reestablished.

Cecal Diseases↗
PubMed1979

Epidemiologic and bacteriologic evaluation of neonatal necrotizing enterocolitis.

The incidence of necrotizing enterocolitis (NEC) in our neonatal unit has varied from 4.7% to zero to 4.4% during three time periods. Simultaneously, significant changes have occurred in the spectrum of bacterial species in the gastrointestinal tract of unaffected infants in the same unit. During the first period of increased attack rate, 82% of gastric and 88% of fecal Enterobacteriaceae were E. coli and K. pneumoniae. When the attack rate decreased the frequencies were 11% (gastric) and 47% (fecal), and P. mirabilis was retrieved with increased frequency. The return of E. coli and K. pneumoniae as the dominant organisms was associated with an increase in NEC. Infants with NEC, compared with controls, had a statistically significant increased frequency of retrieval of E. coli and K. pneumoniae from gastric and fecal samplings. The data suggest an active role for certain enteric bacteria in the pathogenesis of NEC.

Enterocolitis, Pseudomembranous↗
PubMed1977

The surgical management of neonatal necrotizing enterocolitis.

Twelve infants with necrotizing enterocolitis were treated surgically in the 2 year period from 1973 to 1974. Resection of gangrenous intestine and proximal enterostomy was preferred in 11 patients. There were four deaths: two were grossly premature infants, one died from electrolyte disturbances related to the proximal enterostomy, and one was an apparent cot death. Intravenous nutrition was used routinely in all cases in the postoperative period. The problems of recommencement of enteral feeding and ileostomy dysfunction are discussed briefly.

Enterocolitis, Pseudomembranous↗
PubMed1979

Neonatal necrotizing enterocolitis: implications for an infectious disease.

There is a broad spectrum of presentations and severity of necrotizing enterocolitis. Because it may have several different causes, ncerotizing enterocolitis may be a syndrome rather than a specific disease. The triad of formula feeding, intestinal ischemia, and bacterial growth may be part of the pathogenesis of necrotizing enterocolitis. Bacteria are of central importance for the production of pneumatosis, a prerequisite of which is formula feeding. Bacteria may also contribute to the intestinal injury seen after ischemia. However, the disease in the low risk patient seen during an epidemic associated with a single organism is probably caused by a primary gastrointestinal infection. On the other hand, in the stressed newborn infant with mucosal injury the presence of the appropriate bacteria may be all that is needed to initiate the chain of events leading to necrotizing enterocolitis. Figure 2 illustrates the importance of bacteria in all the causes proposed to be involved in the pathogenesis of necrotizing enterocolitis. Whether bacteria are primary or secondary agents, necrotizing enterocolitis should always be approached therapeutically as an infectious disease.

Bacterial Infections↗
PubMed1977

Heat-stable enterotoxigenic Escherichia coli and necrotizing enterocolitis: lack of an association.

During an outbreak of diarrhea in a special care nursery caused by heat-stable enterotoxigenic Escherichia coli (serotype 078:H11:K80), nine (4.3%) of the 205 infants in the nursery developed necrotizing enterocolitis. Cases of necrotizing enterocolitis were not significantly more common in infants colonized or infected with these organisms; heat-stable enterotoxigenic E. coli was isolated from 5(56%) of nine cases of necrotizing ecterocolitis and from 27(38%) of the 71 infants without necrotizing enterocolitis who were also cultured. Our findings suggest that caution should be taken in implicating enterotoxigenic E. coli as a cause of necrotizing enterocolitis.

Animals↗
PubMed1979

Transcutaneous oxygen (tcPO2) measurements as an aid to fluid therapy in necrotizing enterocolitis.

Impaired peripheral perfusion is a major problem in necrotizing enterocolitis with delayed recognition and definite documentation being primary factors. While blood pressure and other clinical measurements may improperly estimate the severity of the problem, changes in transcutaneous oxygen measurements and their relationship to arterial oxygen (the tcPO2/PaO2 ratio) potentially afford a sensitive measurement of peripheral perfusion. Experience in our unit confirms a close relationship between tcPO2/ and PaO2 being 0.97 +/- 0.04 (SE). Ten infants with birth weights of 640 to 1380 g, who subsequently developed necrotizing enterocolitis, had strikingly lower ratios initially (0.00, 0.00, 0.00, 0.17, 0.21, 0.43, 0.44, 0.48, and 0.56). Use of the tcPO2/PaO2 ratio to monitor fluid therapy was related to outcome, suggesting that this ratio is important in managing necrotizing enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1979

Changes in the incidence of necrotizing enterocolitis associated with variation of the gastrointestinal microflora in neonates.

The incidence of necrotizing enterocolitis was noted to vary in association with significant variation in the gastrointestinal microflora cultured from infants in the neonatal intensive care unit. Increased colonization with E. coli and K. pneumoniae was associated with an increased incidence of necrotizing enterocolitis, which suggests that these organisms are related to the pathogenesis of necrotizing enterocolitis.

Digestive System↗
PubMed1978

Spontaneous resolution of colonic strictures caused by necrotizing enterocolitis: therapeutic implications.

Colonic strictures are now a well recognized complication in infants surviving necrotizing enterocolitis. We describe the clinical course of seven infants with colonic strictures after necrotizing enterocolitis. Only two demonstrated the finding of fixed fibrotic stricture described in the literature, while the remaining five showed atypical radiographic and pathologic features. Two of the five showed partial or spontaneous resolution of post-necrotizing enterocolitis colonic stenoses on follow-up barium enema studies. In three of four patients with colonic resections, the histopathologic examination revealed a surprising absence of irreversible fibrosis or cicatrix formation. Current surgical practice dictates elective resection of these narrowed colonic segments. The radiologic and pathologic findings in our series of patients suggest surgical resection may be unnecessary in selected cases.

Colon↗
PubMed1979

Operative techniques for the treatment of neonatal necrotizing enterocolitis.

Operative management of infants with necrotizing enterocolitis and its complications requires a repertoire of surgical techniques, many of which are unique to pediatric surgery. Survival rates for infants with this once deadly illness are improving. Choice of the correct operative procedure and precise technical performance of the technique are mandatory for survival of the infant.

Abscess↗
PubMed2026

Association between packed red blood cell transfusion and clinical deterioration in neonatal necrotizing enterocolitis: a systematic review and meta-analysis.

BACKGROUND: No systematic review has evaluated the existing evidence regarding the association between packed red blood cell (pRBC) transfusion and clinical worsening of necrotizing enterocolitis (NEC) in neonates. This systematic review and meta-analysis was conducted to address this knowledge gap. MATERIALS AND METHODS: We searched the Cochrane Library, EBSCO, Embase, Web of Science, Google Scholar, and PubMed for studies on pRBC transfusion and NEC published before May 10, 2025. Relevant articles were selected through title, abstract, and full-text screening. English-language case-control studies or cohort studies, or randomized controlled trials involving newborns with NEC that compared pRBC transfusion with no transfusion and reported changes in NEC clinical status were included. Review articles, systematic reviews, case reports, editorials, animal studies, duplicate publications, and studies with incomplete data were excluded. RESULTS: Five studies involving 971 neonates with NEC were included. The pooled analysis demonstrated a potential association between pRBC transfusion and clinical deterioration of NEC in neonates (odds ratio: 6.05, 95% confidence interval: 3.02-12.14). CONCLUSIONS: pRBC transfusion was associated with an exacerbation of NEC in neonates. However, these findings should be interpreted cautiously because of the small number of eligible studies included in this meta-analysis, and future large-scale, well-designed studies are needed to confirm the observed association.

Humans↗