Necrotizing Enterocolitis (NEC)
This gastrointestinal disease primarily affects premature infants, infecting, inflaming, and eventually destroying part of the infant’s bowel. Although it affects only one infant in 2,000 to 4,000 births, (up to 5 percent of neonatal intensive care unit admissions), it is the most common and serious gastrointestinal disorder among hospitalized preterm infants.
Necrotizing enterocolitis (NEC) typically begins within the first two weeks of life, because premature infants have immature bowels that are sensitive to changes in blood flow and prone to infection. They may have difficulty with blood and oxygen circulation and digestion, which increases their chances of developing NEC. However, the exact cause of NEC is unknown. Experts suspect that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow, and when milk feedings are begun, the added stress of moving food through the intestine allows bacteria to damage the intestinal wall. The damage may affect only a short segment of the intestine, or it may progress quickly to involve a much larger portion.
The infant will begin to look sick if bacteria continue to spread through the wall of the intestines and into the blood, and may develop mineral imbalances. In severe cases the intestine may perforate, allowing bacteria to leak into the abdomen and causing life-threatening PERITONITIS. Because the infant is physically immature, even with quick treatment there may be serious complications.
Some experts believe that NEC can be triggered by the type of infant formula and its rate of delivery, or the immaturity of the mucous membranes. (Babies who are fed breast milk can also develop NEC, but their risk is lower.) Another theory is that babies who have had difficult deliveries with low oxygen levels can develop NEC. When there is not enough oxygen, the body sends the available oxygen and blood to vital organs instead of the gastrointestinal tract, and NEC can result. Babies with an increased number of red blood cells also seem to be at higher risk, because too many red blood cells thicken the blood and hinder the transport of oxygen to the intestines.
NEC sometimes seems to occur in epidemics, affecting several infants in the same nursery, which suggests that in some cases the infection could be spread from one baby to another, despite the fact that all nurseries have very strict precautions to prevent the spread of infection.
Symptoms
The symptoms of NEC may vary from one baby to the next, and may mimic other digestive problems, but they include:
• poor tolerance to feedings
• food stays in stomach longer than expected
• decreased bowel sounds
• bloating and abdominal tenderness
• greenish vomit
• red abdominal skin
• increase or drop in number of stools
• bloody stools
Other symptoms include periodic stoppage of breathing, slowed heart rate, diarrhea, lethargy, and fluctuating body temperature. Advanced cases may show fluid in the abdominal cavity, infection of the membrane lining the abdomen, or shock.
Diagnosis
NEC is usually confirmed by the presence of an abnormal gas pattern seen on an X ray. A surgeon may need to withdraw fluid from the abdomen to determine whether the intestines have perforated.
Treatment
Most babies with NEC do not need surgery. Treatment includes stopping feedings, sending a tube through the nasal passages to the stomach to remove air and fluid from the stomach and intestine, intravenous fluids, antibiotics, and frequent examinations of the abdomen. If the swollen abdomen interferes with breathing, extra oxygen or a ventilator is used to help the baby breathe.
If the treatment is successful, the baby may be able to be fed normally within 72 hours, although in most cases feedings are withheld and antibiotics are continued for seven to 10 days. Severe cases may require the removal of part of the intestine.
Most infants recover completely, but sometimes the bowel may be so scarred and narrowed that it causes future intestinal obstruction or interferes with the absorption of nutrients. This is more common in children who required surgery for NEC and had part of their intestine removed.
Necrotizing enterocolitis (NEC) typically begins within the first two weeks of life, because premature infants have immature bowels that are sensitive to changes in blood flow and prone to infection. They may have difficulty with blood and oxygen circulation and digestion, which increases their chances of developing NEC. However, the exact cause of NEC is unknown. Experts suspect that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow, and when milk feedings are begun, the added stress of moving food through the intestine allows bacteria to damage the intestinal wall. The damage may affect only a short segment of the intestine, or it may progress quickly to involve a much larger portion.
The infant will begin to look sick if bacteria continue to spread through the wall of the intestines and into the blood, and may develop mineral imbalances. In severe cases the intestine may perforate, allowing bacteria to leak into the abdomen and causing life-threatening PERITONITIS. Because the infant is physically immature, even with quick treatment there may be serious complications.
Some experts believe that NEC can be triggered by the type of infant formula and its rate of delivery, or the immaturity of the mucous membranes. (Babies who are fed breast milk can also develop NEC, but their risk is lower.) Another theory is that babies who have had difficult deliveries with low oxygen levels can develop NEC. When there is not enough oxygen, the body sends the available oxygen and blood to vital organs instead of the gastrointestinal tract, and NEC can result. Babies with an increased number of red blood cells also seem to be at higher risk, because too many red blood cells thicken the blood and hinder the transport of oxygen to the intestines.
NEC sometimes seems to occur in epidemics, affecting several infants in the same nursery, which suggests that in some cases the infection could be spread from one baby to another, despite the fact that all nurseries have very strict precautions to prevent the spread of infection.
Symptoms
The symptoms of NEC may vary from one baby to the next, and may mimic other digestive problems, but they include:
• poor tolerance to feedings
• food stays in stomach longer than expected
• decreased bowel sounds
• bloating and abdominal tenderness
• greenish vomit
• red abdominal skin
• increase or drop in number of stools
• bloody stools
Other symptoms include periodic stoppage of breathing, slowed heart rate, diarrhea, lethargy, and fluctuating body temperature. Advanced cases may show fluid in the abdominal cavity, infection of the membrane lining the abdomen, or shock.
Diagnosis
NEC is usually confirmed by the presence of an abnormal gas pattern seen on an X ray. A surgeon may need to withdraw fluid from the abdomen to determine whether the intestines have perforated.
Treatment
Most babies with NEC do not need surgery. Treatment includes stopping feedings, sending a tube through the nasal passages to the stomach to remove air and fluid from the stomach and intestine, intravenous fluids, antibiotics, and frequent examinations of the abdomen. If the swollen abdomen interferes with breathing, extra oxygen or a ventilator is used to help the baby breathe.
If the treatment is successful, the baby may be able to be fed normally within 72 hours, although in most cases feedings are withheld and antibiotics are continued for seven to 10 days. Severe cases may require the removal of part of the intestine.
Most infants recover completely, but sometimes the bowel may be so scarred and narrowed that it causes future intestinal obstruction or interferes with the absorption of nutrients. This is more common in children who required surgery for NEC and had part of their intestine removed.
Tags: gastrointestinal disease, infant’s bowel, NEC, Necrotizing Enterocolitis, PERITONITIS, premature infant
Posted in Health and Wellness
