Necrotising enterocolitis Flashcards

1
Q

What is necrotising enterocolitis (NEC)?

A

NEC is the most frequent and lethal gastrointestinal emergency in preterm newborn infants. It is characterized by acute inflammation and variable damage to the intestinal tract, ranging from mucosal injury to full-thickness necrosis and perforation.

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2
Q

What is the incidence of NEC in low birth weight infants?

A

The incidence of NEC is about 6 to 7% in low birth weight infants (less than 1500g).

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3
Q

What is the overall mortality rate of NEC?

A

The overall mortality rate of NEC is 30 to 50% despite advancements in neonatal care.

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4
Q

Antenatal risk factors

A
  1. Maternal hypertension.
  2. Maternal drug use (cocaine).
  3. Maternal infection / chorioamnionitis.
  4. Placental abruption.
  5. Perinatal hypoxia
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5
Q

What do antenatal risk factors lead to

A

These antenatal factors may lead to circulatory instability, reduced mesenteric blood
flow and bowel ischaemia.

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6
Q

Postnatal risk factors

A
  1. Prematurity
  2. Non- human milk formula/ enteral feeding
  3. Disruption of commensal gut bacteria and presence of pathogenic bacteria
  4. Blood transfusion
  5. Patent ductus arteriosus
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7
Q

How does decreasing gestational age affect the risk of necrotising enterocolitis (NEC)?

A

Decreasing gestational age is associated with an increased risk of NEC.

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8
Q

What factors contribute to the increased risk of NEC in premature infants?

A

Premature infants have an immature mucosal barrier with increased permeability, reduced concentrations of IgA, mucosal enzymes, and protective factors such as lactoferrin, contributing to the increased risk of NEC.

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9
Q

What is the protective effect of human milk compared to formula in relation to NEC?

A

Human milk compared to formula is more protective against NEC due to the decrease in foreign antigens and the presence of protective factors.

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10
Q

Are slow advancement and delayed initiation of feeds associated with a reduced risk of NEC?

A

No, slow advancement and delayed initiation of feeds are NOT associated with a reduced risk of NEC.

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11
Q

Is there a confirmed causal relationship between blood transfusions and necrotising enterocolitis (NEC)?

A

Transfusion-associated NEC has been described, but a causal relationship is yet to be established.

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12
Q

How does a patent ductus arteriosus (PDA) contribute to the risk of necrotising enterocolitis (NEC)?

A

A patent ductus arteriosus (PDA) results in left-to-right shunting, leading to reduced post-ductal and systemic blood flow, which may contribute to the risk of NEC.

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13
Q

systemic signs

A

Respiratory distress,
apnoea,
lethargy,
irritability,
poor feeding, temperature
instability,
poor perfusion

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14
Q

abdominal signs

A

-Abdominal distension or tenderness,
-abdominal wall erythema or induration,
-localised abdominal -
-mass,
-ascites,
-large gastric aspirates,
-blood or bile-stained
vomitus,
-ileus and bloody stools.

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15
Q

Blood studies (not specific for NEC)

A
  • Neutropaenia and thrombocytopaenia on FBC.
  • Elevated C-reactive protein / CRP.
  • Metabolic acidosis and increased lactate.
  • Electrolyte abnormalities.
  • Deranged coagulation profile.
  • Blood and CSF culture
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16
Q

Stools

A

Stool occult blood.

17
Q

Abdominal X ray

A
  • The radiological hallmark sign for NEC is pneumatosis intestinalis, which appears
    as bubbles of gas in the bowel wall. Other radiological features include, thickened
    bowel walls and abnormal bowel gas pattern, portal or hepatic venous air and
    pneumoperitoneum.
18
Q

Modified Bell’s Staging Criteria: Stage 1

A

suspected NEC

19
Q

Modified Bell’s Staging Criteria: Stage 2

A

definite NEC

20
Q

Modified Bell’s Staging Criteria: Stage 3

A

advanced NEC.

21
Q

What is the initial approach to medical management for newborn infants with Bell’s stage I or II necrotising enterocolitis (NEC)?

A

The initial approach involves non-operative management, including discontinuation of enteral feeds, decompression of intestinal contents with a nasogastric tube, bowel rest, antibiotic treatment, and correction of electrolyte or coagulation abnormalities.

22
Q

What supportive measures should be provided during bowel rest in NEC management?

A

During bowel rest, intravenous fluid or parenteral nutrition should be given, and feeds should be reintroduced slowly.

23
Q

What are the indications for surgical management in necrotising enterocolitis (NEC)?

A

Indications for surgery include pneumoperitoneum with likely bowel perforation, clinical deterioration despite aggressive medical therapy, presence of fixed dilated loop of bowel, and evidence of peritonitis or gangrenous bowel.

24
Q

What are the goals of surgery in NEC management?

A

The goals of surgery are to resect necrotic bowel, decompress the intestine, free intraperitoneal air, and preserve as much of the bowel length as possible.

25
Q

What are the most common late complications of necrotising enterocolitis (NEC)?

A

The most common late complications of NEC include stricture formation and short bowel syndrome.

26
Q

What is the most important preventative strategy to reduce the risk of NEC?

A

Human milk instead of formula is the most important strategy to reduce the risk of NEC.

27
Q

What should be considered if mother’s own milk is unavailable for preterm, low birth weight infants?

A

If mother’s own milk is unavailable, pasteurized donated human milk should be considered for preterm, low birth weight infants.

28
Q

What has been shown to reduce the risk of NEC and can be used as a prophylactic measure?

A

Prophylactic probiotic administration has been shown to reduce the risk of NEC.

29
Q

What infection control measures help ensure a lower risk of NEC?

A

Strict infection control measures, such as handwashing and avoidance of overcrowding within the nursery, help ensure a lower risk of NEC.