Neonatal necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in newborns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.Alimentary tract of infant showing intestinal necrosis, pneumatosis intestinalis, and perforation site (arrow). Autopsy.Closeup of intestine of infant showing necrosis and pneumatosis intestinalis. Autopsy.Gross pathology of neonatal necrotizing enterocolitis. Autopsy of infant showing abdominal distension, intestinal necrosis and hemorrhage, and peritonitis due to perforation. Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in newborns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile. The exact cause is unclear. Risk factors include congenital heart disease, birth asphyxia, exchange transfusion, and premature rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging. Prevention includes the use of breast milk and probiotics. Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics. Surgery is required in those who have free air in the abdomen. A number of other supportive measures may also be required. Complications may include short-gut syndrome, intestinal strictures, or developmental delay. About 7% of those that are born premature develop necrotizing enterocolitis. Onset is typically in the first four weeks of life. Among those affected, about 25% die. The sexes are affected equally frequently. The condition was first described in between 1888 and 1891. The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth (i.e., the earlier a baby is born, the later signs of NEC are typically seen). Initial symptoms include feeding intolerance and failure to thrive, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support. The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities, most commonly radiography. Specific radiographic signs of NEC are associated with specific Bell's stages of the disease: Ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs, specifically in cases that involve a paucity of bowel gas, a gasless abdomen, or a sentinel loop. Diagnosis is ultimately made in 5–10% of very low-birth-weight infants (<1,500g). Prevention includes the use of breast milk and probiotics. A 2012 policy by the American Academy of Pediatrics recommended feeding preterm infants human milk, finding 'significant short- and long-term beneficial effects,' including reducing the rate of NEC by a factor of two or more.