Necrotising enterocolitis Flashcards
Definition
Portion of the bowel undergoes ulceration and necrosis
Most commonly affected area
Ileum and colon
Epidemiology
1-5% preterm infants in NICU
Clinical presentation
Within first few days of life Feeding intolerance, delayed gastric emptying Abdominal distension Blood stools Ileus- decreased bowel sounds Evidence of perforation
Etiology (3)
Hypoxic-ischemic injury Enteral feeding Infection
Describe hypoxic-ischemic injury mechanism
Associated with hyotension, anemia, PDA, indomethacin, umbilical vessel catheterisation Intestinal injury due to reduced ability of neonate to regulate intestinal blood flow Tissue hypoxia= mucosal injury and bacterial invasion
Describe the enteral feeding mechanism
Never seen (usually) until enteral feeds +nutrient absorption= +oxygen demand–> GI dysmotility and stasis->+bacterial growth and invasion of ischemic mucosa and ischemic stress
Describe the infectious disease mechanism
+Bacterial proliferation
Risk factors (5)
Preterm
Physical exam findings (think systemic and system)
Systemic- lethargy, poor feeding, febrile, jaundice CV- hypotension, +CRT Resp- tachypnea, distress, apnea GI- distension, tenderness, erythema, hematochezia, +aspirated, billous vomiting
Findings when perforation
Sepsis Shock Peritonitis DIC
Investigations
FBC ABG Lactate Coagulation UEC, LFTs Blood and stool culture Abdominal xray
Findings on FBC
Leukocytosis or -ve Anemia Thrombocytopenia Repeat every 6 hours
Findings on BC
Negative- must exclude bacterial sepsis
Findings on serum electrolyte panel
Hyponatremia
What is the pathognomonic finding on AXR and what is the finding
Pneumostasis intestinalis Train-track lucency->intramural bubbles are gas produced by bacteria
