Necrotizing enterocolitis: A continuing problem in the neonate

Abstract

Necrotizing enterocolitis (NEC) is a syndrome of diverse etiologies with a significant mortality rate affecting mostly prematurely born stressed infants. Now recognized as a discrete entity, it had been poorly defined because other conditions seem to represent the same entity. A number of risk factors have been identified that appear to "trigger" NEC, though these have been questioned because they have been present just as frequently in premature and older infants who did not develop NEC as in those that did. Recently, maternal cocaine use has been added to the suspected risk factors. A steady improvement in the survival of babies with NEC has been due largely to a high index of suspicion of the disease and early, aggressive medical management.

Necrotizing Enterocolitis in Full-Term or Near-Term Infants: Risk Factors

“…We could not confirm the relation between polycythemia and NEC described in other investigations [2,3,13]. There arc sev eral possible mechanisms for cocaine-induced gastrointestinal ischemia, but a definite cau sal relation between fetal cocaine exposure and NEC is still uncertain [14][15][16], In this study no differences were found in maternal drug exposure among the NEC and the con trol group.…”

“…Several investigators have pointed out the role of infectious agents as possible factors in the development of NEC [1,8,9,16]. The pathology of NEC is consistent with the inter action of epithelial cells with bacterial toxins [17], There is a long list of organisms that have been related to NEC, but no specific bac teria or virus has been associated with most of the cases.…”

“…Epi demic outbreaks are often associated with an increased incidence of gastrointestinal dis eases in adult caretakers, suggesting the pres ence of a transmissible agent [17], E. coli and Klebsiella have been linked with certain out breaks [16], but no specific agent has been consistently isolated. However, the use of in fection control methods during an epidemic outbreak should limit the spread of the dis ease [19], Before onset of NEC, 91% of infants had been fed with infant formula, none had breast milk.…”

“…The pathology of NEC is consistent with the inter action of epithelial cells with bacterial toxins [17], There is a long list of organisms that have been related to NEC, but no specific bac teria or virus has been associated with most of the cases. The most common organisms arc gram-negative rods, Klebsiella and E. coli [ 16,18], Twenty percent of our NEC patients had bacteriemia, 80% of them had advanced NEC; it is most likely that this represents bac terial translocation through a previously in jured intestinal wall rather than the initial event [17,19], Clostridia deserve special men tion, since they have been isolated in about 20% of cases [9] usually producing more se vere gangrene and higher mortality [18], In this study the patient with C. perfringens in peritoneal culture had a severe course and died in 24 h.…”

Enterocolite Necrosante: avaliação entre os fatores de risco e de proteção com a gravidade e o desfecho da doença

“…Apesar de ainda não haver consenso sobre a unicausalidade no seu desenvolvimento [1,2,8,9], o nascimento prematuro tem sido citado como o principal fator de risco para a ECN [1][2][3][4][5][6][7][8][9][10][11], acrescido da isquemia, presença de bactérias patogênicas e substrato metabólico no trato gastrointestinal. Tais fatores agindo simultaneamente no intestino imaturo do recém-nascido pré-termo (RNPT) têm sido reconhecidos pelos neonatologistas como pré-requisitos para o desenvolvimento da ECN há mais de 50 anos [1,2,10,12].…”