Necrotizing Enterocolitis


  • The cause of necrotizing enterocolitis remains incompletely understood but is likely multifactorial.
  • Although there is a higher incidence in premature infants, it may be seen in the term newborn as well.
  • Time of onset:
    < 30 weeks EGA:  ave. time of onset = 20.2 days
    31-33 weeks EGA:  ave. time of onset = 13.8 days
    > 34 weeks EGA:  ave. time of onset 5.4 days
    Term infants:  usually develop in first 1-3 days of life

Presentation:

  • Initial symptoms may range from feeding intolerance and abdominal distention, to bloody stools, erythema or discoloration of the abdominal wall, apnea, and shock.
  • Starts with feeding intolerance, then--> vomiting, diarrhea.
    – Clinical triad may ultimate develop
    a) abdominal distension
    b) bloody stools, and
    c) Pneumatosis intestinalis*** (pathognomonic)

Diagnosis:

  • X-ray: pneumatosis intestinalis (intramural air) and hepatic portal air.
  • Free air in the abdomen may be seen if the bowel is perforated and is best ascertained from x-rays in the left lateral decubitus position where free air can be seen above the liver.

Management:

  • NGT decompression, antibiotics, TPN.
  • Management is directed by symptoms and typically includes bowel rest and broad-spectrum antibiotics such as ampicillin, cefotaxime, and clindamycin to cover gram-positive, gram-negative, and anaerobic organisms.
  • A pediatric surgeon should be consulted or a transfer arranged to an appropriate facility after stabilization

Pneumatosis intestinalis


 
TE Fistula /
Esophageal Atresia
GERD Pyloric Stenosis Duodenal Atresia Malrotation/
Volvulus
Necrotizing  Enterocolitis Intussusception Intersitnal Atresia
- Frothing, Bubbling
- Excessive salivation
- Chocking w/ 1st feed
- 20-30 miin after feeding
- Spitting up
- Present since birth
 
- Non-Bilious
- Projectile
- NOT present at birth
- Hungry baby
- HypoChloremic, Hypokalemic
- Metabolic Alkalosis
- Present AT BIRTH
- Vomit with feed
- BILIOUS
- Associated w/ Down Syndrome
 
-Bilious vomiting
-infant age <1 year
-dark blood in diaper
-abdominal distension
- Pre-term Baby
- Intramural Air
- Distended Abdomne
- (+) Blood in stool
-age 6 to 12 months
-male gender
-abdominal pain
-vomiting
-lethargy/irritability
-blood per rectum/currant jelly stool
-hypovolemic shock

 

MC site: Jejunal Atresia
- Bilious vomit at birth
- Distended Abdomen
  Dx:
- 24 hr pH monitoring
- Reflux scan
Dx:
US
Dx:
- Abd XR = Double Bubble
Dx:
-
Upper GI contrast series
-CT abdomen (WITH oral and IV contrast)
-Abdominal plain films
-CBC, ABG
-
Ultrasound
- lower GI contrast series
Dx:
- ABD XR = pneumonitis intestinalis or free air.
Dx:
- abdominal plain-film x-ray
-ultrasound
- diagnostic enema
- CT Abd
DX:
- Abd XR = Triple Bubble
  Tx:
Reglan 0.2mg/kg/dose

Ranitadine 10mg/kg/day
Tx:
Surgery
Tx:
- NG, Surgery
Tx:
Surgery
Tx:
- Bowel rest (NPO)
-
cefotaxime
- Pediatric surgeon Consult
Tx:
-IV Fluid
-Barium enema
-ABx
-Surgery