Necrotizing enterocolitis: Difference between revisions

Latest revision as of 22:17, 7 October 2021

Background

Abbreviation: NEC
Intestinal necrosis in previously well infant
Typically presents in 1st week of life, with case reports to 6 months in children that are chronically ill.
Predominantly affects preemies; 10-15% occurs in full-term patients
Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production

Clinical Features

Poor feeding, lethargy, abdominal distention/tenderness
Sepsis, pneumoperitoneum

Differential Diagnosis

Pediatric Abdominal Pain

Evaluation

Neonate with necrotizing enterocolitis.

Left: KUB with pneumatosis intestinalis (large arrow) a specific finding in necrotizing enterocolitis. Right: follow-up film showing free air indicating bowel perforation (small arrow).

Work-Up

CBC
Chem
Sepsis evaluation
Coags
Stool +/- heme positive

Radiography

Pneumatosis on XR is hallmark
- Get KUB in supine position and left lat decubitus
Ultrasound
- Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
- Assess for gas bubbles in liver and portal veins

Management

NPO
Aggressive IV hydration
Ampicillin + gentamicin + clindamycin
Surgery consult

Disposition

Admit

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+*Abbreviation: NEC
+*Intestinal necrosis in previously well infant
+*Typically presents in 1st week of life, with case reports to 6 months in children that are chronically ill.
+*Predominantly affects preemies; 10-15% occurs in full-term patients
+*Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production
+==Clinical Features==
+*[[Failure to thrive (peds)|Poor feeding]], [[altered mental status (peds)|lethargy]], [[abdominal pain|abdominal distention/tenderness]]
+*[[Sepsis]], pneumoperitoneum
-* usu 24-48 hr of life/neonates & premature infants
+==Differential Diagnosis==
-* It is d/t intestinal wall necrosis
+{{Pediatric abdominal pain DDX}}
-==Diagnosis==
+==Evaluation==
+[[File:Necrotizing enterocolitis 202.jpg|thumb|Neonate with necrotizing enterocolitis.]]
+[[File:PMC3800332 IJA-57-387-g001.png|thumb|Left: [[KUB]] with pneumatosis intestinalis (large arrow) a specific finding in necrotizing enterocolitis. Right: follow-up film showing free air indicating bowel perforation (small arrow).]]
+===Work-Up===
+*CBC
+*Chem
+*[[Sepsis (peds)|Sepsis]] evaluation
+*Coags
+*Stool +/- heme positive
+===Radiography===
+*Pneumatosis on XR is hallmark
+**Get [[KUB]] in supine position and left lat decubitus
+*[[Ultrasound: Abdomen|Ultrasound]]
+**Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
+**Assess for gas bubbles in liver and portal veins
-* S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools
+==Management==
-* radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen
+#NPO
+#Aggressive [[IVF|IV hydration]]
+#[[Ampicillin]] + [[gentamicin]] + [[clindamycin]]
+#Surgery consult
-Clinical triad : Abdominal. Distension + GI bleeding + Pneumatosis intestinalis
+==Disposition==
+*Admit
+==See Also==
+*[[Abdominal pain (peds)]]
-Signs of functional Intestinal obstruction : Abdominal distension, progressive decreased Peristalsis, Bilious vomiting, hematemesis and blood in stools
+==References==
+<references/>
-Signs of peritonitis & perforation: Ascites, erythema & edema of abdominal wall, localized mass or rigidity
+[[Category:Pediatrics]]
+[[Category:GI]]
+[[Category:Surgery]]
-Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema
-Triad of:
-Thrombocytopenia
-Metabolic acidosis
-Hyponatremia
-Stools are heme +
-Radiography
--Pneumotosis is hallmark
-Get KUB and left lat decubital
-==DDx==
-Sepsis, pneumonia, malro/volvulus, intuss, feeding intolerance (exclusion)
-==Treatment==
-* Rx= 80% nd only medical mgt (bowel rest, ngt, fluids, abx to cover bowel flora), 20% need bowel surgery (if perf etc)
-* 15% mortality
-Management
--NPO
--CBC, lytes, BCx, x-ray
--Abx x 48 hrs
--Serial CBC, lytes, x-ray (q6)
-Treatment:
-NG to suction
-NPO
-Amp/gent/clinda
-Volume replacement
-Support
-Surgery indications
--Perforation, portal/biliary air, rapidly deteriorating
-==Source==
-Adapted from Pani
-[[Category:Peds]]