Necrotising enterocolitis

Necrotising enterocolitis

NEC is a patchy haemorrhagic enteritis seen in about 10% of preterm babies on NICUs; all are more than a few days old and have been fed. NEC is less common in breastfed than in formula-fed babies. NEC commonly involves the colon and terminal ileum, less commonly the jejunum and rarely the duodenum. Mild NEC presents with feed intolerance, bilious aspirates, distension and rectal bleeding /uni00A0 – /uni00A0 gut rest, antibiotics and PN may be su ffi cient treatment. If tenderness and signs of sepsis are present surgical intervention may be needed, especially if there is a deterioration needing mechanical venti lation and inotropes. Some can be observed closely for a short time. A laparotomy is needed if there is no improvement, a persistent mass, worsening obstruction, perforation, or further e a rapidly progressing deterioration. The sickest babies hav multiorgan failure with a discoloured abdomen ( Figure 18.10 and a mortality of around 30%. Radiological signs include pneumatosis intestinalis ( Figure 18.11 ), gas in the portal vein and if perforated, a pneumoperitoneum. A peritoneal drain can occasionally be su ffi cient, but definitive surgery is usually needed. At laparotomy ( Figure 18.12 ), bowel resection and anastomosis or a defunctioning stoma are options. In the sick est babies, dead intestine is removed, open bowel ends closed (clip and drop), and the abdomen left open (laparostomy) with a vacuum dressing applied on low suction. Definitive surgery follows stabilisation. Survivors with >40 /uni00A0 cm of small intes ver a few months, but others may need tine usually adapt o prolonged admissions or home PN.

Figure 18.9 Water-soluble contrast in meconium ileus showing a microcolon.

Necrotising enterocolitis

NEC is a patchy haemorrhagic enteritis seen in about 10% of preterm babies on NICUs; all are more than a few days old and have been fed. NEC is less common in breastfed than in formula-fed babies. NEC commonly involves the colon and terminal ileum, less commonly the jejunum and rarely the duodenum. Mild NEC presents with feed intolerance, bilious aspirates, distension and rectal bleeding /uni00A0 – /uni00A0 gut rest, antibiotics and PN may be su ffi cient treatment. If tenderness and signs of sepsis are present surgical intervention may be needed, especially if there is a deterioration needing mechanical venti lation and inotropes. Some can be observed closely for a short time. A laparotomy is needed if there is no improvement, a persistent mass, worsening obstruction, perforation, or further e a rapidly progressing deterioration. The sickest babies hav multiorgan failure with a discoloured abdomen ( Figure 18.10 and a mortality of around 30%. Radiological signs include pneumatosis intestinalis ( Figure 18.11 ), gas in the portal vein and if perforated, a pneumoperitoneum. A peritoneal drain can occasionally be su ffi cient, but definitive surgery is usually needed. At laparotomy ( Figure 18.12 ), bowel resection and anastomosis or a defunctioning stoma are options. In the sick est babies, dead intestine is removed, open bowel ends closed (clip and drop), and the abdomen left open (laparostomy) with a vacuum dressing applied on low suction. Definitive surgery follows stabilisation. Survivors with >40 /uni00A0 cm of small intes ver a few months, but others may need tine usually adapt o prolonged admissions or home PN.

Figure 18.9 Water-soluble contrast in meconium ileus showing a microcolon.

Necrotising enterocolitis

NEC is a patchy haemorrhagic enteritis seen in about 10% of preterm babies on NICUs; all are more than a few days old and have been fed. NEC is less common in breastfed than in formula-fed babies. NEC commonly involves the colon and terminal ileum, less commonly the jejunum and rarely the duodenum. Mild NEC presents with feed intolerance, bilious aspirates, distension and rectal bleeding /uni00A0 – /uni00A0 gut rest, antibiotics and PN may be su ffi cient treatment. If tenderness and signs of sepsis are present surgical intervention may be needed, especially if there is a deterioration needing mechanical venti lation and inotropes. Some can be observed closely for a short time. A laparotomy is needed if there is no improvement, a persistent mass, worsening obstruction, perforation, or further e a rapidly progressing deterioration. The sickest babies hav multiorgan failure with a discoloured abdomen ( Figure 18.10 and a mortality of around 30%. Radiological signs include pneumatosis intestinalis ( Figure 18.11 ), gas in the portal vein and if perforated, a pneumoperitoneum. A peritoneal drain can occasionally be su ffi cient, but definitive surgery is usually needed. At laparotomy ( Figure 18.12 ), bowel resection and anastomosis or a defunctioning stoma are options. In the sick est babies, dead intestine is removed, open bowel ends closed (clip and drop), and the abdomen left open (laparostomy) with a vacuum dressing applied on low suction. Definitive surgery follows stabilisation. Survivors with >40 /uni00A0 cm of small intes ver a few months, but others may need tine usually adapt o prolonged admissions or home PN.

Figure 18.9 Water-soluble contrast in meconium ileus showing a microcolon.