Necrotising enterocolitis Flashcards
What is necrotising enterocolitis (NEC)?
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.
What is the incidence of NEC in low birth weight infants?
The incidence of NEC is about 6 to 7% in low birth weight infants (less than 1500g).
What is the overall mortality rate of NEC?
The overall mortality rate of NEC is 30 to 50% despite advancements in neonatal care.
Antenatal risk factors
- Maternal hypertension.
- Maternal drug use (cocaine).
- Maternal infection / chorioamnionitis.
- Placental abruption.
- Perinatal hypoxia
What do antenatal risk factors lead to
These antenatal factors may lead to circulatory instability, reduced mesenteric blood
flow and bowel ischaemia.
Postnatal risk factors
- Prematurity
- Non- human milk formula/ enteral feeding
- Disruption of commensal gut bacteria and presence of pathogenic bacteria
- Blood transfusion
- Patent ductus arteriosus
How does decreasing gestational age affect the risk of necrotising enterocolitis (NEC)?
Decreasing gestational age is associated with an increased risk of NEC.
What factors contribute to the increased risk of NEC in premature infants?
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.
What is the protective effect of human milk compared to formula in relation to NEC?
Human milk compared to formula is more protective against NEC due to the decrease in foreign antigens and the presence of protective factors.
Are slow advancement and delayed initiation of feeds associated with a reduced risk of NEC?
No, slow advancement and delayed initiation of feeds are NOT associated with a reduced risk of NEC.
Is there a confirmed causal relationship between blood transfusions and necrotising enterocolitis (NEC)?
Transfusion-associated NEC has been described, but a causal relationship is yet to be established.
How does a patent ductus arteriosus (PDA) contribute to the risk of necrotising enterocolitis (NEC)?
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.
systemic signs
Respiratory distress,
apnoea,
lethargy,
irritability,
poor feeding, temperature
instability,
poor perfusion
abdominal signs
-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.
Blood studies (not specific for NEC)
- Neutropaenia and thrombocytopaenia on FBC.
- Elevated C-reactive protein / CRP.
- Metabolic acidosis and increased lactate.
- Electrolyte abnormalities.
- Deranged coagulation profile.
- Blood and CSF culture