Necrotic enterocolitis is an inflammatory disease that affects the intestines. In most cases, it occurs in premature infants or infants with low body weight. Despite the fact that pathology is not common, complications arising in the presence of this disease can lead to serious consequences, even death. Therefore, it is very important to know the causes of necrotic enterocolitis in newborns in order to minimize the risk of developing the disease.
Disease Description
Necrotic enterocolitis is an acquired disease characterized by the development of necrosis and ulcers on the intestinal mucosa, and sometimes on its deeper layers. This diagnosis suggests the likelihood of partial or complete destruction of the intestine. In pediatric classes, lectures on necrotic enterocolitis are given great importance, because despite the fact that the disease occurs infrequently, the consequences from it can be very serious.
The first signs of the disease, in most cases, appear within two weeks of the birth of the baby. The smaller the body weight of the baby at birth, the more it is susceptible to the development of necrotic enterocolitis. In premature babies, internal organs are still underdeveloped and more susceptible to the effects of infections that can cause the disease.
Possible reasons
The exact causes of necrotizing enterocolitis in newborns are still unknown. Experts identify several factors that can provoke the development of pathology in premature babies. These include:
- Underdeveloped intestinal tissue.
- Pathology of organs.
- Hypoxia that occurred in the perinatal period.
- Ischemia.
- Arterial hypotension.
- Immaturity of the immune system.
- An allergy to milk protein, which can occur when feeding a baby with a mixture.
- Hemolytic conditions.
- Blood transfusion.
- Unsuitable nutrition for the newborn.
- Birth injuries of the central nervous system.
- Exposure to bacteria.
- Hereditary factor.
At the first feeding, bacteria enter the intestines of the baby, which create pathogenic flora in it. Due to the fact that the tissues of the organ are still underdeveloped, exposure to pathogenic agents can lead to damage to the internal walls of the intestine. With the rapid progression of the disease, extensive foci of inflammation can occur. Bacteria continue to affect the walls of the affected organ, causing erosion, and with further spreading deeper into the intestinal tissue - its perforation, due to which the infection can enter the abdominal cavity, causing peritonitis.
Cases of a group occurrence of a pathological condition in the intensive care unit were noted. It is assumed that the cause could be infections that were transmitted from one child to another.
An interesting fact is that among children who are breast-fed, the percentage of cases is significantly lower compared to children receiving artificial nutrition.
Pathology classification
Some experts divide necrotic enterocolitis in premature infants into several forms, which depend on the rate of development of the disease.
- Sharp. In most cases, it occurs in children who weigh more than 1500 g. First, abdominal symptoms occur, and after a few hours the child's condition worsens. If timely treatment is not prescribed, this stage quickly flows into a more dangerous one.
- Subacute. Occur in premature infants with a body weight of less than 1500 g. With this form, cases of relapse are possible. First, abdominal manifestations occur, and somatic symptoms develop more slowly.
- Lightning fast. A very dangerous form of the disease. It occurs in full-term children, but with abnormalities of the development of the digestive tract. The first sign with this form is a general malaise. After that, intestinal perforation may occur within two days.
Also, early enterocolitis, which occurs in the first day of a baby’s life, and late, which appears during the first two weeks after birth, are also distinguished.
The following types are distinguished depending on the degree of damage to the organ:
- Local. Affects a limited intestine.
- Polysegmented. The defeat of the organ occurs immediately in several areas.
- Total. A very dangerous type of disease. Pathological processes cover the entire intestine.
Ulcerative necrotic enterocolitis is also distinguished. Its formation occurs against the background of a long inflammatory process. The formation of ulcers is possible at various depths, which in the future can lead to perforation.
Symptoms
The symptoms of ulcerative necrotic enterocolitis include the following conditions:
- Violations of the stool. It may concern both an increase in its volume and a decrease.
- Lack of appetite.
- Bloating.
- Increased gas formation.
- Redness of the skin.
- Drowsiness and lethargy.
- Pressure on abdomen.
- Presence of bile or blood in the vomit.
- Lack of peristalsis.
- Delayed food in the stomach.
- Blood in the stool.
The following signs of the disease may also occur:
- Bradycardia
- Apnea.
- Body temperature is unstable.
- Fluid in the abdomen.
Many symptoms are similar to manifestations of other gastrointestinal diseases, therefore, when observing any of the above symptoms, you should consult a doctor as soon as possible.
Diagnostic measures
Diagnosis of ulcerative necrotic enterocolitis in newborns will include:
- Anamnesis, which clarifies the symptoms, pregnancy, the presence of chronic pathologies and a hereditary factor.
- The surgeon examines the child - listening to the abdomen for intestinal sounds, palpation, in which the degree and localization of pain is determined.
- Be sure to carry out laboratory tests of urine and blood, according to the results of which the leukocyte formula and platelet level are determined. The analysis is repeated every 6 hours.
- Coagulogram.
- Electrolytes.
- Bacteriological and viral studies.
- Feces for occult blood.
- Ultrasound diagnostics.
- Roentgenography.
- MRI or CT.
Treatment
Therapy should be prescribed by the doctor based on the results of the analysis. It is strictly forbidden to engage in self-medication, as this can lead to irreparable consequences. Timely started therapy significantly increases the likelihood of recovery. Clinical recommendations for necrotic enterocolitis will depend on the condition of the child and the stage of the disease.
If a pathology is suspected, the following procedures are used:
- First of all, stop feeding. Nutrients are administered intravenously.
- Antibiotic therapy, which is a key treatment. In most cases, penicillin-type drugs are used together with aminoglycosides, which, in the absence of positive dynamics, can be replaced by cephalosporin group antibiotics (for example, Ceftriaxone).
- Use of a nasogastric tube to remove fluid and air bubbles from the intestines and stomach. But it is worth noting that this method is not recommended for children prone to apnea.
- The introduction of drugs that stabilize blood pressure.
- Infusion therapy.
- Vitamin Therapy.
- Reception of probiotics.
- Frequent x-ray, blood test and examination of the baby.
- If there is a strong bloating, which interferes with the implementation of the respiratory function, additional oxygen is supplied using a special apparatus.
If the child’s body responds well to drug therapy, after a few days, a return to enteral nutrition can be carried out. Better start with breast milk. If this type of nutrition is impossible for some reason, it is recommended to use mixtures such as Nenatal, Alprem, Nutramigen.
Surgical intervention
In the most complicated cases of necrotic enterocolitis in newborns, clinical recommendations will include surgery. Its volume and method of conducting will depend on the degree of intestinal damage.
The operation is indicated for the following manifestations of the disease:
- Ulcerative necrotic enterocolitis.
- Peritonitis.
- Tumor processes.
- Necrosis.
- Removal of purulent contents from the abdominal cavity.
- The surgical method is indicated in cases where conservative therapy does not bring a quick result, and the condition of the child worsens. With this treatment option, an economical resection of the affected area is performed, and healthy tissues are sutured. Strom excretion may be required.
After the operation and rehabilitation of the abdominal cavity, antibiotic therapy is necessary in order to exclude the development of the inflammatory process.
Some time after the procedure, the second stage of the operation may be required to restore intestinal patency.
A timely surgical intervention significantly increases the chances of recovery.
Possible consequences of the disease
Unpleasant consequences can occur not only due to the disease itself, but also be a consequence of the prescribed therapy.
- When taking certain antibiotics, hearing problems may occur. Therefore, when using these drugs in treatment, it is necessary to control their level in the blood of the child.
- Disorders of the kidneys.
- Pathology of the liver can cause prolonged intravenous nutrition.
- After surgery, intestinal obstruction may develop. Scars or a narrowing of the organ contribute to this.
- Lowering blood pressure.
- Bleeding.
Prevention
The basis of preventive measures will be the maintenance of a healthy image during pregnancy, the passage of all screening studies and analyzes. After birth, breastfeeding is recommended, as it is noted that children who are breast-fed are less likely to develop pathology.
Forecast
The prognosis for necrotic enterocolitis directly depends on the stage of the disease, the condition of the child and the timeliness of care. When therapy is started on time, the probability of a full recovery can reach up to 50% of all cases.
The risk of serious consequences is higher in very premature babies.
Conclusion
Necrotic enterocolitis is a dangerous disease with a high probability of death, which occurs in the complete absence of treatment or its untimelyness. In some cases, the development of pathology occurs very quickly, so it is important to monitor the condition of the child, especially if there is a fact of severe prematurity. Such children are more prone to developing the disease.
It is very important to observe preventive measures in order to exclude the likelihood of developing intrauterine pathologies of the fetus, which are one of the main reasons for the development of necrotic enterocolitis. If any of the above symptoms appear, you should immediately contact a medical institution, because early diagnosis and treatment started in most cases leads to a complete recovery.