Necrotizing enterocolitis in newborns is the most common cause of death in the early neonatal period. The main link in the development is ischemia of the intestinal wall. The classification of neonatal NEC includes three stages that parents should pay attention to at the slightest suspicion of this disease.
Reasons
There are many causes of neonatal NEC. This is:
- Perinatal fetal hypoxia - chronic fetoplacental insufficiency, fetal intoxication due to drug use, blue-type congenital heart disease (when blood is shunted from right to left), severe anemia of a pregnant woman (oxygen transport to the fetus is impaired).
- Intestinal colonization with bacterial flora with absorption of endotoxins (pathological contamination of the intestine, infectious diseases of the mother, prolonged catheterization of the umbilical vessels).
- Physiological featurespremature babies (due to its immaturity, the barrier function of the intestinal mucosa is reduced, the concentration of the mucosal protection factor, secretory immunoglobulin A, is low).
- Insertion of a catheter into the umbilical artery by mistake (iatrogenic).
- Microtrauma of the intestinal mucosa (tube feeding with high osmolarity formulas, rapid increase in enteral nutrition).
- Ischemia of the intestinal wall (blood transfusion through the umbilical vessels - the umbilical vein, the introduction of too cold and hyperosmolar solutions).
Risk factors
Risk factors include the following:
- prematurity;
- hemolytic disease of the newborn, which is treated with FRT (exchange transfusion surgery);
- respiratory distress of the newborn (surfactant deficiency);
- IUGR (intrauterine growth retardation).
All of the above causes damage to the mucous membrane of the intestinal wall and trigger the pathogenetic links of enterocolitis.
Hazards
NEC is a serious problem that is accompanied by a very weak condition of the child. There are mild forms of the disease. With them, only a small area in the intestinal region is affected. After the child began to be treated, after the first days he goes to recovery. With complex variations of the disease, important parts of the intestine are damaged. In such cases, the large intestine does not perform a function, this poses a danger to the future life of the child, and the intervention of a surgeon is required.
Duringsurgery, as a rule, the affected area of \u200b\u200bthe intestine is eliminated. If the entire intestine is affected, then medicine may be helpless here. This is the saddest situation in which the baby can no longer be saved.
Symptoms
In the early stages of the disease, NEC has a very poor set of diagnostic symptoms, so the change in the intestinal wall is easily confused with normal infantile colic. As the damaging elements grow - the inflammatory process in the tissues - forced motor reflexes are found in the baby:
- pulling legs to stomach;
- turning on its side;
- trembling hands and a complete refusal to eat, combined with hysterical crying, hysterical sobs.
If you bring your hand to your stomach and move your palm around the navel, the state of arousal increases sharply, which indicates the occurrence of an acute pain syndrome.
Most common symptoms
Clinical guidelines for necrotizing enterocolitis in newborns indicate that the following signs should also alert a young mother:
- bloating;
- gradual increase in its volume;
- increased gas formation;
- impossibility to withdraw exchange products without prior unsoldering;
- sleep disorder;
- whims and nervous excitement when turning over on the stomach;
- a sharp rise in body temperature;
- signs of intoxication (vomiting, diarrhea, pale skin, yellow circlesunder the eyes, lethargy);
- repeated liquid stools of a greenish color with a pungent odor also indicate the occurrence of a complex inflammatory process caused by infection.
If a similar clinical picture occurs, you should immediately call an ambulance and collect a bag for emergency hospitalization.
Ignoring the situation and delaying until morning to call the local pediatrician can cost the baby his life, since the most common complication of necrotizing enterocolitis is peritonitis, purulent contents enter the abdominal cavity, infecting and poisoning all vital organs.
Diagnosis
Necrotizing enterocolitis (NEC) is a disease associated with total damage to the intestinal walls by infectious agents and an acute inflammatory process. A reliable cause of necrotic changes in newborns has not been established. The probable causative agent of NEC is mediators (pathogenic cells), which trigger the process of toxic effects on the fetus.
How this condition is defined:
- Based on the examination data provided by the pediatric surgeon, abnormalities such as bowel sounds, dynamic resistance to palpation as a result of pain, redness of the francs, which indicate peritonitis, will be established. In this situation, the patient is prepared forurgent operation - hospitalized.
- The use of abdominal wall x-ray and ultrasound diagnostics. On the pictures and the monitor of the apparatus, the thickening of the abdominal wall, the accumulation of gases in the intestines, the reflux of blood and gases into the portal vein, the "ladder" phenomenon will be very clearly seen.
- Application of laboratory tests. Blood sampling is carried out to detect intrauterine infections, bacteria and viruses that can infect an infant at the time of birth, in the first weeks of life; the leukocyte formula is examined, which reflects the complete data on the state of the patient's body at the time of treatment.
- In addition, screening studies are prescribed to identify tumor processes, since stenosis and necrotic damage to the intestine are often caused precisely by the blockage of the pathways for excretion of metabolic products and their toxic components. If the presence of a tumor is confirmed, the child is transferred to oncologists. They do follow-up tests and perform surgery.
Treatment
Necrotizing enterocolitis in newborns is a severe inflammatory process of the intestinal mucosa, which is characterized by the presence of membrane formations with the appearance of superficial ulcers. Such a disease is often referred to by the following abbreviation - NEC.
Most often it affects premature babies who were born ahead of schedule. When a child receives food, the intestinal mucosa becomes inflamed and microbes pass into its walls. Often parents do not know how much a newborn child should eat,and overfeed him. As a result, this disease manifests itself. After all, the functions of the intestines (thin and thick) are violated.
Microbes cause infection, resulting in inflammation of the intestinal wall. With the help of a picture of the abdominal cavity, this disease can be detected. At the first signs of necrotizing enterocolitis, a newborn should take blood for tests, including bacteriological. Testing is also required to determine the level of C-reactive protein. C-reactive protein is a sign of various inflammations. This requires consultation with a pediatric surgeon.
Even with quality treatment, it is very difficult to predict how the disease will develop, despite the correct diagnosis. It is necessary to closely monitor the newly born baby during the first two days. Often the child's well-being can worsen when it seemed that everything was getting better. When NEC is diagnosed or suspected, a neonatologist should be consulted. Seeing other specialists, including a surgeon, would not hurt.
After the child has recovered, but he is not gaining weight or hepatic activity is impaired, you should immediately contact a gastroenterologist.
Therapy for necrotizing enterocolitis
Therapy for NEC involves avoiding enteral nutrition and taking antibiotics. The child is transferred to total parenteral nutrition. You should also take drugs that improve blood pressure and key elements in the blood. These are plasma andplatelets. They prevent bleeding and maintain stable breathing. It is also necessary to take blood for analysis every six hours, take pictures of the abdominal organs. You need constant monitoring of the general condition of the body. When a hole is found in the intestine, the work of a surgeon is required. He performs an operation to eliminate the affected places in the intestines. If the child is unstable, the doctor may place a rubber drainage tube in the abdomen to help the newborn to endure the operation.
If your baby responds well to medication, recovery may take about two weeks.
Consequences of NEC
When taking many drugs, you need to keep their blood levels under control all the time, because due to their excessive concentration, the baby will begin to hear badly. The reason lies in the negative impact of antibiotics on the nerve in the inner ear. The most common consequences of NEC are:
- Intestinal ulcer.
- Difficulty breathing.
- Disruption of kidney function.
- Blood pressure drops.
An operation is urgently prescribed if the child is not feeling well and the large intestine does not perform its functions along with the small one. The lack of blood and fluid that occurs during bleeding or inflammation only makes matters worse. Due to low blood pressure, brain activity can suffer. In this case, the baby will need parenteral nutrition. For undefined period. This can harm the functioning of the liver. Approximately 3-6 months after the illness, the following pathology is possible - a slowdown in the functions of the small intestine, an ulcer. This requires the intervention of a surgeon.
If baby has NEC, can he breastfeed?
Young parents are interested in how much a newborn baby should eat. A baby suffering from this ailment, such feeding is strictly contraindicated. At the first signs, and even more so when the diagnosis is confirmed, any enteral feeding is strictly prohibited. The main therapy for necrotizing enterocolitis is gastrointestinal rest and antibiotics. At the first signs of the disease, feeding should be stopped for about a week. When the disease is confirmed, the period is extended by another week.
Follow-up of a child with this disease
At the first signs that the intestines are narrowed or clogged, a contrast x-ray is performed under the supervision of a surgeon. When there is an assumption that it is impossible to digest food, then you should contact a gastroenterologist. Progress in the treatment of NEC can only be achieved through the joint efforts of different specialists. For a baby with necrotizing enterocolitis, further monitoring of its development plays a major role.
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