Necrotizing enterocolitis 46

Necrotizing enterocolitis (NEC) is the most common gastroenterological emergency in the neonatal intensive care unit (NICU) and the major cause of death for all newborns undergoing surgery. The mortality is greater than that from all the congenital disorders of the gastrointestinal tract combined. Survivors may be left with short-bowel syndrome as well as other long-term gastrointestinal, growth and neurodevelopmental sequelae. NEC frequently presents as feed intolerance with bile-stained gastric residuals, abdominal distension, blood in the stools, apnoea, and acidosis. It may develop insidiously, or be a rapidly progressive illness culminating in shock followed by death. The characteristic finding on abdominal radiograph is intramural gas (pneumatosis), produced by bacteria that have invaded the bowel wall. Other radiographic findings include portal gas, persistently dilated loops of bowel and pneumoperitoneum. Immediate management involves stopping enteral feeding, and giving intravenous fluids with broad-spectrum antibiotics. Blood and platelet transfusion may be required. Hypotheses regarding aetiology include the possibility that enteric bacteria ferment maldigested carbohyhdrate creating an acidic intraluminal environment that adversely affects mucosal blood flow. Immaturity of gastrointestinal motor function, digestion, immunity, and circulation are all implicated in the pathogenesis....