Necrotising Enterocolitis, Death Of The Intestinal Tissue In Newborn
Premature babies are at risk for necrotizing enterocolitis (NEC). The condition causes intestinal tissue to die. It can also cause a hole in the intestine. Bacteria can leak through this hole, causing serious abdominal infections. Read the article to know more.
Nivedita Dar17 Jul, 2024
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Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency primarily affecting premature infants and sick newborns. It occurs when the lining of the intestinal wall dies and the tissue falls off. Infants at risk include premature infants, those fed concentrated formulas, infants in nurseries where outbreaks have occurred, and those who have received blood exchange transfusions. Despite advances in neonatal care, NEC remains a significant cause of morbidity and mortality in neonates.
NEC is an inflammatory intestinal disorder characterized by variable damage to the intestinal tract, ranging from mucosal injury to full-thickness necrosis and perforation.Visit - MedEd App
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Etiology/Causes
Although the exact etiology of necrotizing enterocolitis is not fully understood, it is considered multifactorial. Some factors are more frequently encountered in babies with NEC, constituting the classical triggering factors for NEC-like bowel damage. Prematurity is the most recognized predisposing factor for NEC. The majority of infants with NEC are born preterm, and the risk of developing NEC is inversely related to gestational age and birth weight. Prematurity implies immaturity of gut motility and digestion, intestinal circulatory regulation, gut barrier function, and immune defense. Another well-recognized predisposing factor is formula feeding . The mechanism of injury may be fluid shift from the vessels of the gastrointestinal tract to the bowel lumen, resulting in hypoxic (decreased oxygen) injury to the mucosa. Therefore, not only hyperosmolar formulas but any hyperosmolar fluid, including oral medications using hyperosmolar vehicles or contrast media (used in radiodiagnosis), could lead to mucosal injury in the bowel. Hypoxia is a well-studied phenomenon that can lead to NEC. Recurrent episodes of apnea (cessation of breathing), respiratory distress, assisted ventilation, and umbilical vessel catheterization can all contribute to hypoxic events in very low birth weight neonates. Disruption of commensal bacteria , leading to deficient or abnormal microbial colonization of the gut, has been implicated as a key risk factor in the pathogenesis of NEC. The most commonly identified organisms are Escherichia coli.Read More - Radiodiagnosis
Clinical Presentation
NEC typically presents within the first few weeks of life, with the timing being earlier in more premature infants. Clinical signs and symptoms can vary but often include: 1.Gastrointestinal Symptoms: Feeding intolerance, abdominal distension, gastric residuals, and bloody stools. 2.Systemic Symptoms: Apnea, bradycardia, lethargy, and temperature instability. 3.Abdominal Signs: Tenderness, discoloration, and palpable loops of bowel. In advanced cases, pneumoperitoneum due to bowel perforation may be observed.Read More - Pelvis and Perineum
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Prevention
Preventive strategies are crucial in reducing the incidence of NEC. These include: 1.Breastfeeding: Human milk is protective against NEC due to its immunologic properties and favorable influence on gut microbiota. 2.Probiotics: Some studies suggest that probiotics may reduce the risk of NEC by promoting a healthy gut flora. 3.Controlled Feeding Practices: Gradual advancement of enteral feeds and preference for breast milk over formula can reduce the risk.Necrotising Enterocolitis FAQs
What is sepsis and how does it cause end-organ damage?
Sepsis is a life-threatening condition caused by the body’s response to an infection. It can lead to widespread inflammation, blood clotting, and organ dysfunction. The inflammatory response and subsequent immune system reactions can damage tissues and organs, leading to end-organ damage.
What is bowel ischemia?
Bowel ischemia is a condition where there is insufficient blood flow to the intestines, which can lead to tissue damage and necrosis. It can be caused by blockages in the blood vessels, low blood pressure, or blood clots.
Why does lactate rise in bowel ischemia?
Lactate levels rise in bowel ischemia due to anaerobic metabolism. When tissues do not receive enough oxygen, they switch to anaerobic metabolism, producing lactate as a byproduct. Elevated lactate levels are a marker of tissue hypoxia and ischemia.
What are premature and LBW babies?
Premature babies are those born before 37 weeks of gestation. Low birth weight (LBW) babies are those who weigh less than 2500 grams at birth. These infants are at higher risk for complications, including NEC, due to their underdeveloped organs and systems.
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