Necrotizing Enterocolitis Flashcards
Necrotizing enterocolitis (NEC) is an ____________ condition of the ____________ of ____________ that manifests as ____________.
inflammatory ; intestines
neonates
ischaemic necrosis.
NEC
It commonly affects (term or preterm?) babies, ____% of cases are in preterms, 10% of babies weighing <______g develop NEC.
Occurs usually in the _____ to ____ week of life, However it can occur (earlier or later?) in term babies (___________).
preterm ; 90%
1500g ; 2nd to 3rd week
earlier ; 1-3 days
NEC
It can result in _________________ .
Mortality can be as high as ____% in severe cases. Survivors of severe cases have lifelong disabilies.
intestinal perforation.
50%
Aetiology
Aetiology is unknown but it is thought to be multifactorial with the following risk factors:
__________
__________ feeding
Abnormal __________ __________ of the intestine
Babies who have _________
Intestinal __________
Reduced __________ _____________
Drugs
Prematurity
Enteral
bacterial colonization
sepsis
ischaemia
intestinal motility
Aetiology
•Prematurity - incidence is ___________ proportional to gestational age and birth weight. Preterm babies have ________ intestinal mucosa and immunity.
•Enteral feeding – it rarely occurs (before or after?) commencement of enteral feeds, increase incidence with ________ feeds
•Abnormal bacterial colonization of the intestine
-__________ feeding encourages colonization with “harmful bacteria” Clostridium difficile
Exposure to __________ also alter the intestinal flora.
inversely ; immature
before ; formula feeds
delayed ; antibiotics
______ fed babies have more of beneficial bacteria ____________ colonizing the gut as this is enhanced by __________ which is present in breast milk and absent in formula.
Breast
Bifidobacteria
oligofructose
Aetiology
Babies who have ________ may also have abnormal bacteria colonizing the gut.
Drugs
Theophylline ( reduces _____________)
Antacids that reduce gastric acidity such as _________ alter flora composition.
-Indomethacin(splanchnic _________ resulting in impairment of the integrity of the intestine
sepsis
gut motility; Ranitidine
vasoconstriction
Clinical features of NEC
________
________
________
________ intolerance
________ ________
Visible ________
Abdominal wall _________ and tenderness Haematochezia
Apnoea
Reduced ___________
Signs of shock
Lethargy
Fever
Vomitting
Feeding
Abdominal distension
peristalsis; erythema
bowel sounds
Investigations
FBC-_________ total wbc, absolute neutrophil count, _____ platelets, _______ PCV
Electrolytes – _______ sodium may suggest _________ with ________________.
Low bicarbonate may
Blood culture
Stool for ____________
Abdominal Xray - ____________ and __________
Abdominal ultrasound
elevated ; low
low ; low
perforation ; 3rd space loss
occult blood
Anteroposterior ; lateral decubitus
X ray features of NEC
__________ bowel
__________ bowel loop- a single loop or several loops of dilated(enlarged) small intestine are seen in the same position for 24 to 36 hours. This suggests lack of movement of the intestine due to death of that segment of the intestine
__________ bowel wall
Intramural __________ (__________ __________) Portal vein gas
__________
Intraperitoneal fluid
Distended ; Fixed
Thickened ; gas
pneumatosis intestinalis
Pneumoperitoneum
Treatment of NEC
____________ feeds (5-10days)
Intravenous _______ (___________ nutrition)
____________ measurement
Antibiotics including ____________
Correction of electrolytes
____________ abdomen
Supportive care- correct shock if present, blood transfusion if PCV Is low
Surgery if ____________ has occurred
Withhold ; fluids
parenteral ; Abdominal girth
metronidazole; Decompress
perforation
Complications of NEC
__________ ________ __________
Complications of surgery
_____________ syndrome following resection of large segment of necrosed gut (malabsorption, malnutrition)
Intestinal _________ and __________
Poor growth
Poor neurodevelopmental outcome
Disseminated intravascular coagulation
Short bowel syndrome
stricture ; obstruction
Prevention of NEC
Feeding _________.
Minimal ________________ to prime the gut.
Prenatal ________ have been found to reduce incidence.
Gradual increase in ________ of feeds??
breastmilk
enteral feeds early
steroids
volume
