Necrotizing enteritis

Necrotizing enteritis, also known as necrotizing enterocolitis (NEC), is a serious gastrointestinal problem that primarily affects premature infants. It involves the inflammation and, in severe cases, the necrosis (death) of intestinal tissue. The exact cause of NEC is not well understood, but it is believed to result from a combination of factors including intestinal immaturity, an imbalance in intestinal bacteria, and a compromised immune response.

Causes and Risk Factors

The pathogenesis of NEC is multifactorial. Prematurity is the most significant risk factor, with the condition most commonly occurring in infants born before 32 weeks of gestation or weighing less than 1500 grams. Other risk factors include intestinal ischemia, formula feeding (as opposed to breast milk), and bacterial colonization of the intestine. The role of specific pathogens in the development of NEC is still under investigation, but it is thought that an abnormal response by the immature intestine to the colonization by bacteria leads to inflammation and tissue damage.

Symptoms

Symptoms of NEC can vary from mild to severe and may include abdominal distension, bloody stools, feeding intolerance, lethargy, and, in severe cases, septic shock. Early detection and treatment are critical to improving outcomes.

Diagnosis

Diagnosis of NEC is based on clinical signs and symptoms, as well as radiographic findings. Typical radiographic signs include pneumatosis intestinalis (the presence of gas within the walls of the intestines), which is considered pathognomonic for NEC, portal venous gas, and, in severe cases, pneumoperitoneum indicating intestinal perforation.

Treatment

The treatment of NEC depends on the severity of the condition. Initial management includes stopping enteral feeding, gastric decompression, and administration of broad-spectrum antibiotics. In cases where there is intestinal perforation or necrosis, surgical intervention may be required to remove the affected segments of the intestine.

Prevention

Preventative measures for NEC include the use of breast milk, the administration of probiotics, and careful monitoring of at-risk infants. The use of breast milk has been shown to reduce the incidence and severity of NEC, likely due to its immunological and nutritional components.

Prognosis

The prognosis for infants with NEC varies depending on the severity of the disease and the presence of complications. While many infants recover fully with appropriate treatment, NEC can lead to long-term complications such as intestinal strictures, short bowel syndrome, and neurodevelopmental delays.

Epidemiology

NEC primarily affects premature infants, with an incidence rate of 1-5% in neonatal intensive care units. The mortality rate for NEC can be as high as 30%, particularly in cases requiring surgical intervention.