Necrotizing Enterocolitis Flashcards
What is the pathophysiology of NEC?
inflammation of the intestine leading to bacterial invasion causing cellular damage and cellular death and necrosis of the colon and intestine
- ischemia –> necrosis –> perforation
When is necrotizing enterocolitis most likely to affect preterm neonates?
at 2-3 weeks of life, especially when nearing full feeds
What are the 3 most common risk factors for the development of necrotizing enterocolitis?
prematurity, low birth weight, formula feeding
- high osmotic-strength formula
What age group is most at risk for developing necrotizing enterocolitis?
Premature VLBW (< 1500g) children born < 32 weeks
- nearly 90%
- 5x higher incidence in ELBW (<1000g) children born <28 weeks
What percentage of premature children are affected and what is the overall mortality rate?
- affects 2-5% of all premature neonates
- mortality = 10-50%
What are the typical signs and symptoms (4 major) of necrotizing enterocolitis?
- lethargy
- poor appetite/feeding intolerance
- abdominal distension
- bloody stool/vomiting/diarrhea
overall symptoms are NONSPECIFIC
What is the single most important test to make the diagnosis of necrotizing enterocolitis?
What are 3 imaging findings that, while rare, would help make the diagnosis more likely?
ABDOMINAL PLAIN FILM (AP and Left Lateral Decubitus)
Findings: pneumatosis intestinalis, portal venous air, dilated loops of bowel
How often should abdominal imaging be obtained in a patient with necrotizing enterocolitis?
Serially every 6 hours until definitive treatment has occurred
Per Dr. Gurung, what are three (3) common lab values seen in patients with necrotizing enterocolitis?
- hyponatremia
- thrombocytopenia
- acidosis (inc. lactate)
What are the first 3 steps of treatment for a patient with necrotizing enterocolitis?
- NPO with TPN support
- NG tube for bowel decompression
- broad-spectrum antibiotics (Amp/Gent/Metro or Clinda)
How long should patients receive antibiotics and TPN following surgery for necrotizing enterocolitis?
2 weeks
What is the difference between Stage 1, Stage 2, and Stage 3 of necrotizing enterocolitis?
Stage 1 = bowel well thickening
Stage 2 = bowel wall air (pneumatosis)
Stage 3 = bowel wall perforation
Stage 1 and 2 = NPO and Abx
- S1 - 3-5 days
- S2 - 10-14 days
Stage 3 = surgery
How many days should patients with Stage 1 and Stage 2 necrotizing enterocolitis receive antibiotics?
Stage 1 = 3-5 days
Stage 2 = 10-14 days
What are 5 common complications of necrotizing enterocolitis? (LINSS)
- liver failure (prolonged TPN)
- strictures/adhesions
- small bowel syndrome
- nutritional deficiencies
- intestinal failure
Do breastfed premature infants have a lower or higher rate of necrotizing enterocolitis?
LOWER
