Necrotizing enterocolitis

A common disease in the neonates.

Typically occur in premature neonates, oval 10% of cases occurred in full term births. I

The incidence and associated mortality and morbidity has remained unchanged because of the improved survival of the smallest infants.

The mean prevalence is about 7% among infants with birth weight between 500 and 1500 g.

Estimated death rate 20-30%.

The highest death rates are among neonates that require surgery (Fitzgibbons SC et al).

An inflammatory process that starts in the highly immunoreactive intestine and progresses to affect distant organs such as the brain and substantially increases the risk for neurodevelopmental abnormalities.

Infants surviving necrotizing enterocolitis have almost a 25% chance of microcephaly, and serious neurodevelopment delays (Bedrick AD et al).

The disease process is its associated with increased duration of intravenous nutrition in infants, marked increase in the cost of healthcare, and prolonged hospitalization stays.

The need for bowel resection is a severe but common complication, and is the major cause of the development of a short bowel syndrome in pediatric patients.

Neonates present with feeding intolerance, abdominal distention, and bloody stools at 8-10 days of age.

In preterm neonates onset of disease is often the main, but in full-term neonates can develop within the 1st week of life. I

Classic x-ray findings are of pneumatosis intestinlis, portal venous gas or both, are pathognomic.

Early radiographic findings include dilated loops of bowel, decrease gas pattern, and gas filled loops of bowel.

The presence of free and air is indicative of advanced necrotizing enterocolitis.

The process can deteriorate in hours from subtle abominable signs to intestinal perforation, peritonitis, hypotension and death.

While the term necrotizing enterocolitis is reserved for preterm infants, similar symptoms can occur in term and late preterm infants.

The leading cause of mortality among preterm infants.

Case fatality rates of 20-30%.

More than half of very low birth weight infants receive one or more transfusions during hospitalization but no clear-cut relationship excited sets between the incidence of necrotizing enterocolitis and transfusions.

Very severe anemia among very low birth weight infants is associated with increased risk of NEC.

Meta-analyses show that probiotics reduce the incidence of necrotizing enterocolitis in the neonatal period from 6% in the placebo group to 2% in the probiotic group.

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