NEC - NECROTIZING ENTEROCOLITIS Janice Nicklay Catalan M.D...

NECROTIZING
ENTEROCOLITIS
Janice Nicklay Catalan M.D.

OBJECTIVES
•
Ability to diagnose and treat the signs and
symptoms of NEC
•
Ability to evaluate radiographs for the
classic findings of NEC
•
List several long-term complications
associated with NEC

NECROTIZING
ENTEROCOLITIS
•
Epidemiology:
–
most commonly occurring gastrointestinal
emergency in preterm infants
–
leading cause of emergency surgery in neonates
–
overall incidence: 1-5% in most NICU’s
–
most common in VLBW preterm infants
•
10% of all cases occur in term infants

NECROTIZING
ENTEROCOLITIS
•
Epidemiology:
–
10x more likely to occur in infants who have
been fed
–
males = females
–
blacks > whites
–
mortality rate: 25-30%
–
50% of survivors experience long-term
sequelae

NECROTIZING
ENTEROCOLITIS
•
Pathology:
–
most commonly involved areas: terminal ileum
and proximal colon
–
GROSS:
•
bowel appears irregularly dilated with hemorrhagic
or ischemic areas of frank necrosis
–
focal or diffuse
–
MICROSCOPIC:
•
mucosal edema, hemorrhage and ulceration

NECROTIZING
ENTEROCOLITIS
•
MICROSCOPIC:
–
minimal inflammation during the acute phase
•
increases during revascularization
–
granulation tissue and fibrosis develop
•
stricture formation
–
microthrombi in mesenteric arterioles and
venules

NECROTIZING
ENTEROCOLITIS
•
Pathophysiology:
UNKNOWN
CAUSE…….

PRIMARY INFECTIOUS AGENTS
Bacteria, Bacterial toxin, Virus, Fungus
CIRCULATORY INSTABILITY
Hypoxic-ischemic event
Polycythemia
MUCOSAL INJURY
ENTERAL FEEDINGS
Hypertonic formula or medication