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{{Necrotising enterocolitis}}
{{Necrotising enterocolitis}}
==Overview==
'''Necrotizing enterocolitis''' (NEC) is a medical condition primarily seen in [[premature birth|premature]] [[infant]]s, where portions of the bowel undergo [[necrosis]] (tissue death).


==Signs and symptoms==
'''For patient information, click [[Necrotising enterocolitis (patient information)|here]]'''
The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth.  i.e. the earlier a baby is born, the later signs of NEC are typically seen.  Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools.  Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.
 
{{CMG}}
 
{{SK}} Neonatal necrotizing enterocolitis; necrotising enterocolitis, perinatal
==[[Necrotising enterocolitis overview|Overview]]==
 
==[[Necrotising enterocolitis historical perspective|Historical Perspective]]==
 
==[[Necrotising enterocolitis classification|Classification]]==
 
==[[Necrotising enterocolitis pathophysiology|Pathophysiology]]==
 
==[[Necrotising enterocolitis causes|Causes]]==
 
==[[Necrotising enterocolitis differential diagnosis|Differentiating Necrotising Enterocolitis from other Diseases]]==
 
==[[Necrotising enterocolitis epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Necrotising enterocolitis risk factors|Risk Factors]]==
 
==[[Necrotising enterocolitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==
The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities. Plain radiographs of the abdomen are useful by showing evidence of extraluminal gas (pneumatosis, portal venous gas or pneumoperitoneum) or an abnormal bowel gas pattern, particularly a persistently unaltered gas-filled dilated loop of bowel on serial radiographs (fixed loop). More recently [[ultrasonography]] has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs.
[[Necrotising enterocolitis history and symptoms|History and Symptoms]] | [[Necrotising enterocolitis physical examination|Physical Examination]] | [[Necrotising enterocolitis laboratory findings|Laboratory Findings]] | [[Necrotising enterocolitis abdominal x ray|Abdominal X Ray]] | [[Necrotising enterocolitis CT|CT]] | [[Necrotising enterocolitis MRI|MRI]] | [[Necrotising enterocolitis ultrasound|Ultrasound]]  | [[Necrotising enterocolitis other imaging findings|Other Imaging Findings]] | [[Necrotising enterocolitis other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
Treatment consists primarily of supportive care including providing bowel rest by stopping enteral feeds, gastric decompression with intermittent suction, fluid repletion to correct electrolyte abnormalities and third space losses, parenteral nutrition, and prompt antibiotic therapy.  Monitoring is clinical, although serial supine and left lateral decubitus abdominal roentgenograms should be performed every 6 hours.  Signs of radiographic worsening of NEC include dilated bowel loops, pneumatosis intestinalis, portal venous gas, and pneumoperitoneum.  Where the disease is not halted through medical treatment alone, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is required.  This may require a [[colostomy]], which may be able to be reversed at a later time.  Some children may suffer later as a result of [[short bowel syndrome]] if extensive portions of the bowel had to be removed.
[[Necrotising enterocolitis medical therapy|Medical Therapy]] | [[Necrotising enterocolitis surgery|Surgery]] | [[Necrotising enterocolitis primary prevention|Primary Prevention]] | [[Necrotising enterocolitis secondary prevention|Secondary Prevention]] | [[Necrotising enterocolitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Necrotising enterocolitis future or investigational therapies|Future or Investigational Therapies]]
 
==Cause==
NEC has no definitive known cause.  An infectious agent has been suspected, as cluster outbreaks in [[neonatal intensive care unit]]s (NICUs) have been seen, but no common organism has been idenitfied.  A combination of intestinal flora, inherent weakness in the neonatal immune system, alterations in mesenteric blood flow and milk feeding may be factors.  NEC is almost never seen in infants before oral feedings are initiated.
 
==Prognosis==
Typical recovery from NEC if medical, non-surgical treatment succeeds, includes 10-14 days or more without oral intake and then demonstrated ability to resume feedings and gain weight.  Recovery from NEC alone may be compromised by co-morbid conditions that frequently accompany [[prematurity]].  Longterm complications of medical NEC include bowel obstruction and anemia.
Despite a significant mortality risk, long-term prognosis for infants undergoing NEC surgery is improving, with survival rates of 70-80%.  "Surgical NEC" survivors are at-risk for complications including short-bowel syndrome, and neurodevelopmental disability.


==References==
== Case Studies ==
{{reflist|2}}
[[Necrotising enterocolitis case study one|Case #1]]
{{Certain conditions originating in the perinatal period}}
{{Certain conditions originating in the perinatal period}}


Latest revision as of 21:29, 5 March 2013

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Overview

Historical Perspective

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Physical Examination

Laboratory Findings

Abdominal X Ray

CT

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Neonatal necrotizing enterocolitis; necrotising enterocolitis, perinatal

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Necrotising Enterocolitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Abdominal X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1 Template:Certain conditions originating in the perinatal period

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