Necrotizing enterocolitis is an inflammatory disease that affects the intestines. In most cases, it occurs in premature or low birth weight infants. Despite the fact that the pathology is infrequent, the complications that arise in the presence of this disease can lead to serious consequences, up to death. Therefore, it is very important to know the causes of necrotizing enterocolitis in newborns in order to minimize the risk of developing the disease.
Description of the disease
Necrotic enterocolitis is an acquired disease characterized by the development of necrosis and ulcers on the intestinal mucosa, and sometimes on its deeper layers. This diagnosis suggests the likelihood of partial or complete destruction of the intestine. In pediatrics classes, lectures on necrotizing enterocolitis are given great importance, because despite the fact that the disease occurs infrequently, the consequences of it can be very serious.
The first signs of the disease, in mostcases appear within two weeks of the birth of the child. The lower the body weight of the baby at birth, the more he is susceptible to the development of necrotizing enterocolitis. In premature babies, the internal organs are still underdeveloped and are more susceptible to infections that can cause illness.
Possible causes
The exact causes of necrotizing enterocolitis in newborns are still unknown. Experts identify several factors that can provoke the development of pathology in premature babies. These include:
- Underdevelopment of intestinal tissue.
- Pathologies of organs.
- Hypoxia occurring in the perinatal period.
- Ischemia.
- Hypotension.
- Immaturity of the immune system.
- Milk protein allergy that can occur with formula feeding.
- Hemolytic conditions.
- Blood transfusion.
- Inappropriate newborn nutrition.
- Birth injury of the CNS.
- Exposure to bacteria.
- Hereditary factor.
At the first feeding, bacteria enter the intestines of the child, which create pathogenic flora in it. Due to the fact that the tissues of the organ are still underdeveloped, exposure to pathogenic agents can lead to damage to the internal walls of the intestine. With the rapid progression of the disease, extensive foci of inflammation may occur. Bacteria continue to act on the walls of the affected organ, causing erosion, and with further spread deep into the intestinal tissues, itperforation, which can allow infection to enter the abdominal cavity, causing peritonitis.
There were observed cases of group occurrence of a pathological condition in the intensive care unit. It is assumed that the cause could be infections that were transmitted from one child to another.
Interestingly, breastfed babies have a much lower incidence of the disease compared to formula-fed babies.
Classification of pathology
Some experts divide necrotizing enterocolitis in premature babies into several forms, which depend on the rate of development of the disease.
- Spicy. In most cases, it occurs in children who weigh more than 1500 g. First, abdominal symptoms occur, and after a few hours the child's condition worsens. If timely treatment is not prescribed, this stage quickly flows into a more dangerous one.
- Subacute. Occur in premature babies weighing less than 1500 g. With this form, cases of relapse are possible. Abdominal manifestations occur first and somatic signs develop more slowly.
- Lightning fast. A very dangerous form of the disease. It occurs in full-term children, but with anomalies in the development of the digestive tract. The first symptom in this form is a general malaise. After that, within two days, intestinal perforation may occur.
Also, early enterocolitis, which occurs on the first day of a child's life, and late, which manifests itselfwithin the first two weeks after birth.
Depending on the degree of organ damage, the following types are distinguished:
- Local. Affects a limited part of the intestine.
- Polysegmental. Organ damage occurs in several areas at once.
- Total. A very dangerous type of disease. Pathological processes cover the entire intestine.
Also isolated ulcerative-necrotic enterocolitis. Its formation occurs against the background of a long inflammatory process. The formation of ulcers is possible at different depths, which can later lead to perforation.
Symptoms
Symptoms of necrotizing ulcerative enterocolitis include the following conditions:
- Stool disorders. Both an increase in its volume and a decrease may disturb.
- Lack of appetite.
- Bloating.
- Increased gas formation.
- Redness of the skin.
- Drowsiness and lethargy.
- Pain when pressing on the abdomen.
- Presence of bile or blood in vomit.
- No peristalsis.
- Retention of food in the stomach.
- Blood in feces.
The following symptoms may also occur:
- Bradycardia.
- Apnea.
- Body temperature is unstable.
- Fluid in the abdomen.
Many of the symptoms are similar to those of other gastrointestinal diseases, so if you observe any of the above signs, you should contact as soon as possibledoctor.
Diagnostic measures
Diagnosis of necrotizing ulcerative enterocolitis in newborns will include:
- Acquisition of an anamnesis, which specifies the symptoms, the course of pregnancy, the presence of chronic pathologies and the hereditary factor.
- The surgeon examines the child - listening to the abdomen for intestinal noises, palpation, which determines the degree and localization of pain.
- Be sure to conduct laboratory tests of urine and blood, the results of which determine the leukocyte count and platelet count. The analysis is repeated every 6 hours.
- Coagulogram.
- Electrolytes.
- Bacteriological and viral research.
- feces for occult blood.
- Ultrasound diagnostics.
- X-ray.
- MRI or CT.
Treatment
Therapy should be prescribed by a doctor based on the results of the analysis. It is strictly forbidden to self-medicate, as this can lead to irreparable consequences. Timely therapy significantly increases the likelihood of recovery. Clinical recommendations for necrotizing enterocolitis will depend on the condition of the child and the stage of the disease.
If a pathology is suspected, the following procedures are used:
- First of all stop feeding. Nutrients are given intravenously.
- Antibiotic therapy, which is a key treatment. Mostcases, penicillin drugs are used along with aminoglycosides, which, in the absence of positive dynamics, can be replaced with antibiotics of the cephalosporin group (for example, Ceftriaxone).
- Using a nasogastric tube to remove fluid and air bubbles from the intestines and stomach. But it is worth noting that this method is not recommended for use in children prone to sleep apnea.
- Administration of drugs that stabilize blood pressure.
- Infusion therapy.
- Vitamin therapy.
- Probiotic intake.
- Frequent x-rays, blood tests and examination of the baby.
- If there is severe bloating that interferes with the implementation of the respiratory function, additional oxygen is provided using a special device.
If the child's body responds well to drug therapy, a transition back to enteral nutrition can be made after a few days. Better to start with breast milk. If for some reason this dietary option is not possible, it is recommended to use mixtures such as Nenatal, Alprem, Nutramigen.
Surgery
For the most complicated cases of neonatal necrotizing enterocolitis, clinical recommendations will include surgery. Its volume and method of administration will depend on the degree of intestinal damage.
Surgery is indicated for the following manifestations of the disease:
- Ulcerative necrotizing enterocolitis.
- Peritonitis.
- Tumor processes.
- Necrosis.
- Removal of purulent contents from the abdominal cavity.
- The surgical method is indicated in cases where conservative therapy does not bring a quick result, and the child's condition worsens. With this treatment option, an economical resection of the affected area is performed, and he althy tissues are sutured. Strom output may be required.
After the operation and sanitation of the abdominal cavity, antibiotic therapy is necessary to exclude the development of the inflammatory process.
Some time after the procedure, a second stage of surgery may be required to restore intestinal patency.
Surgery performed on time significantly increases the chances of recovery.
Possible consequences of the disease
Unpleasant consequences can occur not only because of the disease itself, but also be a consequence of the prescribed therapy.
- Hearing problems may occur when taking certain antibiotics. Therefore, when using these drugs in treatment, it is necessary to control their level in the child's blood.
- Disorders of the kidneys.
- Liver pathology can cause long-term intravenous nutrition.
- Intestinal obstruction may develop after surgery. This is facilitated by scars or narrowing of the organ.
- Lower blood pressure.
- Bleeding.
Prevention
Basicpreventive measures will be maintaining a he althy lifestyle during pregnancy, passing all screening studies and tests. After birth, breastfeeding is recommended, as it has been observed that children who are breastfed are less susceptible to the development of pathology.
Forecast
Prognosis for necrotizing enterocolitis directly depends on the stage of the disease, the condition of the child and the timeliness of assistance. With timely therapy, the probability of complete recovery can reach up to 50% of all cases.
Severely premature babies are at higher risk of developing serious consequences.
Conclusion
Necrotizing enterocolitis is a dangerous disease with a high probability of death, which occurs in the absence of treatment or its untimeliness. In some cases, the development of pathology occurs very quickly, so it is important to monitor the child's condition, especially if there is a fact of severe prematurity. Such children are more susceptible to developing the disease.
It is very important to observe preventive measures to exclude the possibility of developing intrauterine fetal pathologies, which are one of the main causes of necrotizing enterocolitis. If any of the above signs appear, you should immediately contact a medical facility, because early diagnosis and treatment in most cases leads to a complete recovery.
