Necrotizing enterocolitis in newborns is the most common cause of death in the early neonatal period. The main link in the development is ischemia of the intestinal wall. NEC classification of newborns includes three stages that parents should pay attention to at the slightest suspicion of this disease.
Causes
There are many causes of NEC in newborns. It:
- Perinatal hypoxia of the fetus - chronic fetoplacental insufficiency, intoxication of the fetus due to the use of drugs, congenital heart disease in the blue type (when blood is discharged from right to left), severe anemia of the pregnant woman (oxygen transport to the fetus is impaired).
- Intestinal colonization with bacterial flora with the absorption of endotoxins (pathological intestinal contamination, infectious diseases of the mother, prolonged catheterization of the umbilical vessels).
- Physiological characteristics of premature babies (due to its immaturity, the barrier function of the intestinal mucosa is reduced, the concentration of the mucous membrane protective factor, secretory immunoglobulin A, is low).
- Insertion of a catheter into the umbilical artery by mistake (iatrogenic effect).
- Microtrauma of the mucous membrane of the intestinal wall (feeding through a probe with mixtures with high osmolarity, a rapid increase in the amount of enteral nutrition).
- Ischemia of the intestinal wall (blood transfusion through the umbilical vessels - the umbilical vein, the introduction of too cold and hyperosmolar solutions).
Risk factors
Risk factors distinguish the following:
- prematurity;
- hemolytic disease of the newborn, in which they conduct OZPK (replacement transfusion operation);
- respiratory distress of the newborn (surfactant deficiency);
- IUGR (intrauterine growth retardation).
All of the above reasons lead to damage to the mucous membrane of the intestinal wall and trigger pathogenetic links of enterocolitis.
Hazardous factors
NEC is a serious problem, which is accompanied by a very weak condition of the child. There are mild forms of the disease. With them, only a small area in the intestine is affected. After the child began to be treated, after the first days he goes to recovery. With complex variations of the disease, important areas of the intestine are damaged. In such cases, the large intestine does not perform a function, this carries a danger to the further life of the child, and the intervention of the surgeon is necessary.
During surgery, the affected area of ​​the intestine is usually eliminated. If the entire intestine is affected, then medicine may be helpless. This is the saddest scenario, in which the baby is already impossible to save.
Symptoms
In the early stages of the development of the disease, NEC has a very meager set of diagnostic symptoms, so a change in the intestinal wall can be easily confused with normal infant colic. As the damaging elements grow - an inflammatory process in the tissues - in the baby, forced motor reflexes are detected:
- tightening the legs to the stomach;
- flipping on its side;
- trembling hands and a complete rejection of food in combination with angry crying, hysterical sobs.
If you bring your hand to your stomach and move your palm around the navel, the state of excitement increases sharply, which indicates the occurrence of acute pain.
Most common symptoms
Clinical recommendations of necrotizing enterocolitis in newborns indicate that the following symptoms should also alert the young mother:
- bloating;
- gradual increase in its volume;
- increased gas formation;
- the inability to remove metabolic products without prior soldering;
- sleep disturbance;
- vagaries and nervous excitement when turning on the stomach;
- a sharp rise in body temperature;
- signs of intoxication (vomiting, diarrhea, pallor of the skin, yellow circles under the eyes, lethargy);
- multiple liquid bowel movements of a greenish color with a pungent odor also indicate the occurrence of a complex inflammatory process, the cause of which is infection in the body.
If such a clinical picture occurs, you should immediately call an ambulance and collect a bag for emergency hospitalization.
Ignoring the situation and delaying until the morning to call the local pediatrician can cost the baby life, since the most common complication of necrotizing enterocolitis is peritonitis, purulent contents enter the abdominal cavity, infecting and poisoning all vital organs.
Diagnostics
Necrotizing enterocolitis (NEC) is a disease associated with total damage to the intestinal wall by infectious agents and an acute inflammatory process. A reliable reason for the occurrence of necrotic changes in newborns has not been established. Probable causative agents of NEC are mediators (pathogenic cells), which trigger the process of toxic effects on the fetus.
How is this condition determined:
- Based on the examination data provided by the pediatric surgeon, abnormalities such as intestinal murmurs, dynamic resistance to palpation as a result of pain, redness of the francs that indicate peritonitis will be established. In this situation, the patient is prepared for emergency surgery - they are hospitalized.
- The use of x-rays of the abdominal wall and ultrasound diagnostics. The thickening of the abdominal wall, the accumulation of gases in the intestines, the reflux of blood and gases into the portal vein, and the phenomenon of the “stepladder” will be very clearly visible in the pictures and the monitor of the device.
- The use of laboratory tests. Blood sampling is carried out to detect intrauterine infections, bacteria and viruses that can infect an infant at the time of birth, in the first weeks of life; the leukocyte formula is examined, which reflects complete data on the patient’s body condition at the time of treatment.
- Additionally, screening studies for the identification of tumor processes are prescribed, since often stenosis and necrotic damage to the intestine are caused precisely by overlapping pathways for eliminating metabolic products and their toxic components. If the presence of a tumor is confirmed, the child is passed to oncologists. They conduct refinement studies and perform surgery.
Treatment
Necrotizing enterocolitis in newborns is a severe inflammatory process of the intestinal mucosa, which is characterized by the presence of membrane formations with the appearance of superficial ulcers. Such a disease is often referred to by the following abbreviation - NEC.
Most often, it affects premature babies who were born earlier than planned. When the child receives food, the intestinal mucosa becomes inflamed and the microbes pass into its walls. Often, parents do not know how much a newborn baby should eat, and overfeed it. As a result of this disease is manifested. After all, the functions of the intestine (thin and thick) are violated in this case.
Microbes cause infection, causing the intestinal walls to become inflamed. With the help of a picture of the abdominal cavity, this disease can be detected. At the first signs of necrotizing enterocolitis in a newborn, blood should be taken for analysis, including bacteriological. Testing is still required to detect C-reactive protein levels. C-reactive protein is a sign of various inflammations. To do this, consult a pediatric surgeon.
Even with high-quality treatment, it is very difficult to predict how the disease will develop, despite the correct diagnosis. It is necessary to closely monitor the newly born baby during the first two days. Often, the well-being of a child can worsen when it seemed that everything is recovering. When a diagnosis of "NEC" is made or there is suspicion, you should take the advice of a neonatologist. Inspection of other specialists, including the surgeon, will not hurt.
After the child has recovered, but he has no gain in weight or hepatic activity is impaired, you should immediately consult a gastroenterologist.
Therapy of necrotic enterocolitis
NEC therapy involves the rejection of enteral nutrition and the use of antibiotics. The child is transferred to full parenteral nutrition. You should also take drugs that improve blood pressure and key elements in the blood. These are plasma and platelets. They prevent bleeding and maintain stable breathing. It is also necessary to take blood every six hours for analysis, to take pictures of the organs of the abdominal zone. Need constant monitoring of the general condition of the body. If a hole is found in the intestine, the work of a surgeon is required. He performs an operation to eliminate the affected areas in the intestines. In the case of an unstable condition of the child, the doctor can put a rubber drainage tube in the abdominal cavity so that it is easier for the newborn to undergo surgery.
If the baby responds well to medications, then it may take about two weeks to recover.
Consequences of NEC
When taking many drugs, you need to keep their blood level under control all the time, because due to their excessive concentration the baby begins to hear badly. The reason is the negative effect of antibiotics on the nerve in the inner ear. The most common effects of NEC are:
- Intestinal ulcer.
- Difficulty breathing.
- Impaired kidney function.
- Blood pressure decreases.
An operation is urgently prescribed if the child's health is poor and the colon along with the small one does not perform its functions. The lack of blood and fluid that occurs during bleeding or inflammation only makes things difficult. Due to low blood pressure, brain activity may be affected. In this case, the baby will need parenteral nutrition for an indefinite period. This can harm the liver. About 3-6 months after the illness, the following pathology is possible - a slowdown in the functions of the small intestine, an ulcer. It requires the intervention of a surgeon.
If the baby has NEC, is it possible to breastfeed it?
Young parents are interested in how much a newborn baby should eat. A baby suffering from this ailment, such feeding is strictly contraindicated. At the first signs, and even more so when the diagnosis is confirmed, any enteral feeding is strictly prohibited. The main therapy for necrotic enterocolitis is considered to be the rest of the digestive tract and antibiotics. At the first sign of illness, feeding should be stopped for about a week. When the disease is confirmed, the period increases by another week.
Follow-up control of a child who has had this disease
At the first sign that the intestines are narrowed or clogged, a contrast x-ray is performed under the supervision of a surgeon. When there is an assumption about the impossibility of assimilation of food, then you should consult a gastroenterologist. Progress in the treatment of NEC can only be with the joint activities of different specialists. For a baby with necrotic enterocolitis, the main role is played by further monitoring of its development.