NECROTIZING ENTEROCOLITIS

Question 1

What best describes Necrotizing Enterocolitis (NEC)?
a) A benign condition in newborns
b) A common viral infection
c) A syndrome of intestinal injury characterized by inflammation, bacterial invasion, and necrosis
d) An autoimmune disorder in infants
In NEC, what is the primary consequence of inflammation of the intestine?
a) Increased absorption of nutrients
b) Formation of protective barriers in the intestine
c) Cellular damage, death, and necrosis of the colon and intestine
d) Enhanced intestinal motility
In which group is NEC the most common intestinal emergency?
a) Adolescents
b) School-age children
c) Preterm infants admitted to the Neonatal Intensive Care Unit (NICU)
d) Elderly adults
What is the estimated incidence of NEC in live births?
a) 1 per 100 live births
b) 1-3 per 1,000 live births
c) 1 per 10,000 live births
d) 1 per 100,000 live births
What percentage of infants weighing less than 1,500 grams at birth is at risk of developing NEC?
a) 4-13%
b) 10-15%
c) 25-30%
d) 50-60%

Answer 1

C
C
C
B
A

Question 2

What showed beneficial role in reducing the incidence of NEC

Answer 2

Feeding with human milk has shown a beneficial role in reducing the incidence of NEC

Question 3

What is most consistent and significant factor associated with neonatal NEC and why

Answer 3

Prematurity is associated with:
➢ Decreased integrity of the intestinal mucosal barrier
➢ Depressed mucosal enzymes
➢ Suppressed gastrointestinal hormones pathogenesis of NEC
➢ Suppressed intestinal host defense system
➢ Decreased coordination of intestinal motility

Question 4

———may offer potential benefits for the preterm infant by:

Answer 4

Probiotics
❖ Increasing mucosal barrier function
❖ Upregulating the immune system
❖ Reducing mucosal colonization by potential pathogens.

Question 5

Clinical features of NEC

Answer 5

الجدول صفحه ٢٥

Question 6

Diagnosis of NEC

Answer 6

DIAGNOSIS:

❖ CBC:
➢ Thrombocytopenia
➢ Leukocytosis
❖ Radiographic imaging:
➢ Intestinal ileus → The earliest radiographic finding
➢ Thickening of the bowel loops
➢ Air-fluid levels.
➢ Portal venous gas
➢ Pneumatosis intestinalis:
The pathognomonic radiographic finding
Caused by hydrogen gas production from pathogenic bacteria present between the subserosal and muscularis layers of the bowel wall.

Question 7

Management of NEC

Answer 7

Discontinuation of enteral feedings
❖ Gastrointestinal decompression with nasogastric suction
❖ Fluid and electrolyte replacement
❖ Total parenteral nutrition
❖ Systemic broad-spectrum antibiotics: ampicillin, gentamicin, & metronidazole for anaerobic coverage
❖ Surgical intervention:
➢ The surgical procedure of choice is laparotomy → removal of frankly necrotic & non-viable bowel ➢ Indications for surgery: Presence of a pneumoperitoneum (perforation)
Rapid clinical deterioration despite medical therapy
Abdominal mass
Intestinal obstruction

Question 8

Complications of NEC

Answer 8

COMPLICATIONS:

❖ Intestinal perforation: mortality rate 20-40%
❖ Short bowel syndrome
❖ Peritonitis
❖ Extraintestinal complications include:
➢ Increased risk of bronchopulmonary dysplasia
➢ Neurodevelopmental delay
➢ Sepsis