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NECROTIZING

ENTEROCOLITIS
Atan Baas Sinuhaji

Department of Childhealth,School of
Medicine,University of North Sumatera
Medan

Necrotising Enterocolitis (NEC)


Affects 0.5 to 1 per 1000 live births
Incidence 3-10% in infants < 1500 g
Incidence increase with decreasing
birthweigh and gestational age
Usually affects terminal ileum and
colon to a variable extent
NEC rarely occus before the initiation
of enteral
feeding

NECROTIZING
ENTEROCOLITIS
An Acute Intestinal Necrosis Syndrome Resulting From
Complex Interaction :
= Gut Ischemia
= Poor Mucosal Integrity
= Microbial Infection
= Enteral Nutrition

MUCOSAL INJURY

INTESTINAL PERFORATION

Immaturity

Ischaemia
Milk feeds

Loss of barrier function


Mucosal disruption

Bacterial translocation
Macromolecular absorption

Mucosal damage

Toxins

Bacterial overgrowth
Viruses

NEC

ors
Bacteria

Mucus

enterocyt
Goblet cell
nucleus

ENTERAL FEEDING
1.PROVIDES SUBSTRATE FOR
PROLIFERATION OF
ENTERAL
PATHOGENS
2.HYPEROSMOLAR FORMULA
MUCOSAL
DAMAGE
3.LACK OF IMMUNOPROTECTIVE FACTORS
4.AGGRESSIVE ENTERAL FEEDING
5.BREASTFEEDING
LOWERS THE RISK
OF NEC

Necrotising Enterocolitis (NEC)


Clinical features
Usually occurs in the first two weeks of life
Child is lethargic and apathetic with vomiting
and increasing
abdominal distension
Bloody diarrhoea is a late feature
Progression may be rapid from to mild to
severe after 72 hours
Abdominal examination may show peritonitis
or a mass

Abdominal x-ray may show


Distended bowel with mucosa

edema
Intramural gas ( = pneumatosis
intestinalis )
Portal venous gas or free
intraperitoneal gas

Abdominal x-ray

AA

Abdominal x-ray

Treatment
A. Medical

No definitive

treatment

B. Surgical

1. Perforation
2.Fixed dilated loop on serial x-ray
3.Abdominal wall cellulitis
4.Progressive deterioration despite
maximal medical
support

Medical
1.Preventing futher injury

a. Cessation of feeding
b. Decompression
c. IntraVenous Fluid Drip ( IVFD )
2.Supportive
a. Respiration status
b. Coagulation profile
c. Electrolyte and Acid base balance
d. Antibiotics

PREVENTION
1. EXCLUSIVELY BREAST-FED
2. MINIMAL ENTERAL FEEDS FOLLOWED BY
JUDICIOUS VOLUME ADVANCEMENT
3. PROBIOTIC