🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Necrotising enterocolitis

Medicine > Gastrointestinal

Background knowledge 🧠

Definition

  • Necrotising enterocolitis (NEC) is a serious gastrointestinal condition primarily affecting preterm infants.
  • It involves inflammation and necrosis of the bowel wall, often in the terminal ileum and colon.
  • A medical emergency requiring prompt diagnosis and intervention.

Epidemiology

  • Affects 1-3 in 1000 live births, but up to 7% of infants <1500g.
  • More common in preterm infants (prematurity is the single most important risk factor).
  • Most cases occur in infants born before 32 weeks gestation.
  • Term infants can also be affected, especially if they have congenital heart disease or other risk factors.

Aetiology and Pathophysiology

  • Exact cause unknown, multifactorial with contributions from prematurity, hypoxia, and bacterial colonisation.
  • Hypoxic injury to the bowel results in compromised blood flow, leading to ischaemia and necrosis.
  • Abnormal gut colonisation by bacteria (often Enterobacteriaceae) can trigger inflammation.
  • Feeding, particularly formula feeding, can exacerbate the condition.

Types

  • Spontaneous intestinal perforation (SIP) – perforation without prior NEC, typically in extremely preterm infants.
  • Classic NEC – characterised by inflammation, necrosis, and sometimes perforation.
  • Surgical NEC – where medical management fails, and surgery is required due to perforation or bowel necrosis.

Clinical Features 🌡️

Symptoms

  • Feeding intolerance – vomiting, poor feeding, or residuals in gastric tube.
  • Abdominal distension and discomfort.
  • Lethargy and apnoea episodes.
  • Blood in stools (haematochezia).
  • Temperature instability (especially low temperatures in preterm infants).

Signs

  • Tense, distended abdomen (may feel doughy or firm on palpation).
  • Absent bowel sounds.
  • Visible abdominal veins and erythema of the abdominal wall.
  • Signs of sepsis: tachycardia, hypotension, shock.
  • Deterioration in respiratory status (increased oxygen requirement).

Investigations 🧪

Tests

  • Abdominal X-ray: distended bowel loops, pneumatosis intestinalis, free air under diaphragm (if perforation).
  • Blood tests: full blood count (neutropenia), C-reactive protein (CRP), metabolic acidosis.
  • Blood culture: to identify bacterial pathogens.
  • Abdominal ultrasound: useful to identify bowel wall thickness, free fluid, or portal venous gas.
  • Lactate levels: may help indicate ischaemia.

Management 🥼

Management

  • Initial NBM (nil by mouth), IV fluids, and total parenteral nutrition (TPN).
  • Broad-spectrum antibiotics (typically 3rd generation cephalosporins and anaerobic cover like metronidazole).
  • Nasogastric (NG) tube decompression.
  • Regular clinical and radiological monitoring.
  • Surgical intervention if medical management fails or if perforation occurs.

Complications

  • Short bowel syndrome (due to bowel resection).
  • Sepsis and multi-organ failure.
  • Intestinal strictures, leading to obstruction.
  • Neurodevelopmental delay (due to prolonged critical illness).
  • Death (mortality rate 15-30%).

Prognosis

  • Survival depends on gestational age, birth weight, and promptness of treatment.
  • Early-stage NEC has better outcomes compared to advanced disease.
  • Long-term morbidity includes growth failure, intestinal complications, and developmental delay.

Key points

  • Prematurity is the greatest risk factor for NEC.
  • Early recognition and prompt treatment are essential to improve outcomes.
  • Prevention strategies include promoting breastfeeding and minimising antibiotic overuse.
  • Long-term follow-up is needed to monitor growth and development.

No comments yet 😉

Leave a Reply

Gastrointestinal