Topics Discussed: enterocolitis, necrotizing; gastroenterology and hepatology; gastrointestinal perforation; intestinal perforation.
Excerpt:"Definition. Necrotizing enterocolitis (NEC) is an ischemic and inflammatory necrosis of the bowel primarily affecting premature neonates after the initiation of enteral feeding.
Incidence. NEC is predominantly a disorder of preterm infants, with an incidence of 610% in infants weighing <1500g. Although 10% of all cases of NEC occur in term infants, the incidence is highest in premature infants. NEC has an overall mortality of 1030%.
Pathophysiology. A multifactorial theory has been suggested in which several risk factors including prematurity, formula feedings, ischemia, and bacterial colonization interact to initiate mucosal damage via a final common pathway involving activation of the inflammatory cascade. Mucosal damage results in an invasion of the bowel wall by gas producing bacteria, resulting in an intramural gas accumulation (pneumatosis intestinalis). This sequence of events may progress to transmural necrosis or gangrene of the bowel and finally to multiple sites of bowel perforation and peritonitis.
- Prematurity. There is an inverse relationship between gestational age and a risk for developing NEC. This may involve immature mucosal barrier, mucosal enzymes, and various gastrointestinal hormones. Premature infants may have an imbalance between pro- and anti-inflammatory factors and thus have..."
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