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TAS Neonatal Medicine ✅ > Necrotising Enterocolitis ✅ > Flashcards

Necrotising Enterocolitis ✅ Flashcards

1
Q

What % of VLBW infants will develop NEC?

A

15-25%

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2
Q

How is a diagnosis of NEC made?

A

Clinical diagnosis

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3
Q

How does NEC present?

A
  • Abdominal distention and tenderness
  • Bilious aspirates
  • Bloody stools
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4
Q

What is found on AXR in NEC?

A

Intramural air (pneumatosis intestinalis)

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5
Q

What can NEC progress too?

A

Peritonitis and bowel perforation

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6
Q

What causes NEC?

A

Exact cause unknown, but probably multifactorial including loss of bowel mucosal integrity

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7
Q

What does a loss of bowel mucosal integrity lead to?

A

Macromolecular absorption and bacterial translocation

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8
Q

What is there a significant deficiency of in NEC?

A

Secretory IgA

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9
Q

Does NEC increase the permeability of the intestine to small or large molecules?

A

Both

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10
Q

What can reduce the risk of NEC?

A

Antenatal glucocorticoid therapy

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11
Q

Why does antenatal glucocorticoid therapy reduce the incidence of NEC?

A

It improves intestinal maturation and reduces permeability

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12
Q

What may initiate the process in NEC?

A

Infection

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13
Q

How may infection initiate the process in NEC?

A

By causing mucosal injury leading to invasion of gas producing bacteria

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14
Q

What can invasion of the bowel mucosa with gas-producing bacteria result in?

A

Pneumatosis intestinalis

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15
Q

What gas is in the bowel wall in NEC?

A

Mainly nitrogen and hydrogen

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16
Q

Other than the bowel wall, where may gas be found in NEC? -

A

In the portal venous system

17
Q

What is found histologically in NEC?

A

Necrosis of the mucosa with;

  • Microthrombus formation
  • Patchy mucosal ulceration
  • Oedema
  • Haemorrhage
18
Q

What substances play an important role in the pathogenies of NEC?

A
  • Cytokines

- Inflammatory markers

19
Q

What inflammatory markers play an important role in NEC?

A
  • Interleukins
  • Tumour necrosis factor alpha
  • Platelet activating factors
20
Q

What causes enterocyte death in NEC?

A
  • Imbalance in the pro and anti-inflammatory mediators

- Increased pro-apoptotic protease activity

21
Q

Which part of the bowel is affected in NEC?

A

Any part of small or large bowel may be affected, but terminal ileum or sigmoid colon is usually involved

22
Q

What are the risk factors for NEC?

A
  • Prematurity
  • Hypoxia-ischaemia to the bowel
  • Feeding factors
  • Infection
23
Q

What is the main risk factor for NEC?

A

Prematurity

24
Q

What are the prenatal causes of hypoxia-ischaemia to the bowel?

A
  • IUGR

- Perinatal asphyxia

25
Q

When in particular is IUGR a risk factor for NEC?

A

If absent or reversed end-diastolic flow of fetal arteries

26
Q

What are the post-natal causes of hypoxia-ischaemia to the bowel?

A
  • PDA
  • Reduced blood flow
  • Asphyxia
27
Q

What can cause a reduced blood flow to the bowel in the post-natal period?

A
  • Umbilical catheters

- Indomethacin

28
Q

What are the feeding risk factors for NEC?

A
  • Rapid increase in enteral feeds
  • Formula milk
  • Hypertonic formula
29
Q

What are the infectious risk factors for NEC?

A

Bacteria in intestinal wall and/or blood stream

30
Q

What is the role of anaemia in the development of NEC?

A

Proposed that it leads to compromise of the mesenteric blood flow causing intestinal hypoxia and mucosal injury

31
Q

Does transfusion affect outcomes in NEC?

A

Can predispose to NEC

32
Q

How can blood transfusion predispose to NEC?

A

Transfusion-related repercussion gut injury (TRAGI) of the hypoxaemic gut has been postulated to predispose anaemic preterm infants to NEC

33
Q

Are probiotics helpful in NEC?

A

Benefit remains unproven

34
Q

How is NEC managed?

A
  • Stop feeds
  • Large bore naso/orogastric tube for intestinal decompression
  • Start broad spectrum antibiotics
  • Provide supportive care
35
Q

When might surgical intervention be required for NEC?

A
  • Bowel perforation

- Failure of medical treatment

36
Q

What are the surgical options for the management of NEC?

A
  • Peritoneal drainage at the bedside

- Resection of non-viable bowel and anastomosis or ileostomy and colostomy

TAS Neonatal Medicine ✅ (35 decks)

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