perinatal necrotizing enterocolitis

Necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is an intestinal disease that affects premature or very low birth weight infants. It is characterized by the permeability of the neonatal bowel wall to bacteria with associated inflammation and ischemia. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and potentially death. The exact cause is unclear. However, several risk factors have been identified. Consistently described risk factors include formula feeding, intestinal dysbiosis, low birth weight, and prematurity. Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging. Maternal factors such as chorioamnionitis, cocaine abuse, intrauterine growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, pre-eclampsia, and smoking have not been consistently implicated with the development of NEC. Prevention includes the use of breast milk and probiotics. Treatment includes bowel rest, orogastric tube, intravenous fluids, and intravenous antibiotics. Surgery is required in those who have free air in the abdomen. A number of other supportive measures may also be required. Complications may include short-gut syndrome, intestinal strictures, or developmental...