necrotising enterocolitis
| Headline | |
|---|---|
| Etiology | Disproportionate inflammatory response in immature bowel to enteral feeding. Site: terminal ileum, caecum, ascending colon. Onset: most common in week 2-3 of life. |
| Epidemiology | Risk factors: very low birth weight infants most at risk. Prematurity (↑ if <32/40), IUGR, hypoxia, polycythaemia, exchange transfusion 1-5% incidence in the NICU population! |
| Clinical presentation | Think intra-abdominal septic picture. abdo pain + distension, rectal bleeding, bilious vomiting. All other nasty sequelae of sepsis: Disseminated intravascular coagulation, intestinal perforation, hepatic portal venous gas Radiology: portal venous gas, pneumatosis intestinalis, dilated bowel loops, thumb printing |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | - Fluid resuscitation - Broad spectrum antibiotics - for gut translocation, hence gram neg and anaerobic cover - TPN - Immunomodulation: steroids? probiotics? - Surgical interventions: resection, drainage, anastomosis |
| Prevention | Breast milk, gradual introduction of enteral feeding in preterm infants |