Pneumatosis intestinalis in a preterm infant: should we treat all intestinal pneumatosis as necrotising enterocolitis?

Abstract

Gastric pneumatosisis a very rare site of pneumatosis intestinalis (PI), and we report this finding in a preterm female infant with cyanotic congenital heart disease. The infant was stable initially on nasal intermittent mandatory ventilation; however, torrential pulmonary flow through a large patent ductus arteriosus prompted closure using oral ibuprofen. After an episode of haematochezia, she developed PI, affecting mainly the gastric wall and small intestine with portal venous gas. Her bowel movements were regular, with no abdominal distension or significant gastric aspirates. She was haemodynamically stable with negative infective markers. Management consisted of endotracheal intubation and ventilation, gastric decompression and broad-spectrum antibiotics. Both the gastric and intestinal pneumatosis resolved within 24 hours and she made an uneventful recovery. If PI is not due to necrotising enterocolitis, enteral nutrition can be initiated early and prolonged course of broad-spectrum antibiotics could have been avoided.

Preterm baby with gastric pneumatosis: a new association with a desirable outcome

“…Several conditions were reported to be associated with GP 1–4. None of the previously reported conditions was encountered in the case of this baby.…”

“…The condition may follow a benign course with excellent outcome. The management strategy of necrotising enterocolitis is not strictly required 4…”

Gastric pneumatosis in a preterm infant: A case report

“…[3] There is another serious type called emphysematous gastritis which shows inflammation and ischemia of the gastric mucosa and is often seen in fulminant necrotizing enterocolitis. [4] There have been rare cases of sepsis due gas producing organisms like E.coli, Proteus, Clostridium spp, staph aureus, Enterobacter, etc. leading to this condition.…”

Gastric pneumatosis in a preterm infant following initial empiric antibiotic therapy

“…[2][3][4][5] Other causes of gastric pneumatosis include isolated gastric pneumatosis, sepsis, gastritis, congenital hypertrophic pyloric stenosis, displaced gastric tubes, following steroid and cyclooxygenase inhibitor (COX-inhibitor), for example, Ibuprofen exposure, jejunal atresia and non-invasive positive pressure ventilation, especially in babies with cyanotic congenital heart disease and large patent ductus arteriosus. [6][7][8][9] Learning points ► Initial empiric use of antibiotics should not be routinely administered for preterm infants on delivery as it is strongly associated with intestinal dysbiosis and increased incidence of NEC. ► The use of early antibiotic therapy for preterm infants after delivery should be restricted to indicated cases with risk factors of early-onset sepsis.…”