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NECROTIC ENTEROCOLITIS IN NEWBORNS: CLINICAL PICTURE,
DIAGNOSIS AND TREATMENT
Agadjanova Shaira Khalilovna
Scientific supervisor:
Head of the department of pediatrics and neonatology
of the faculty, associate professor, ASMI
Shakhobiddinova Nodirabegim Khabibullo kizi
Independent researcher: ASMI
https://doi.org/10.5281/zenodo.13933176
Abstract.
One of the most severe diseases in newborns, necrotic
enterocolitis, is analyzed from a modern standpoint. The causes and risk factors
for the development of the disease are considered. The features of the
pathogenesis and microbiological status of newborns are shown. The clinical
picture of necrotic enterocolitis is covered in detail, the clinical stages of the
disease, on which its classification is based, are analyzed.
Kеywоrds:
necrotic enterocolitis, intestinal necrosis, intestinal diseases in
newborns.
INTRОDUСTIОN
Necrotizing enterocolitis (NEC) is one of the most severe diseases in
newborns, in which the target organ is the intestine. The first report on this
disease was published in 1964, and the first work reflecting the experience of
surgical treatment of enterocolitis appeared in print in 1967.
MАTЕRIАLS АND MЕTHОDS
According to foreign authors, NEC occurs with a frequency of 2.4 per 1000
newborns, which is 2.1% of all children admitted to neonatal intensive care
units; according to domestic authors, it occurs with a frequency of 4%. From a
clinical point of view, NEC is characterized by a wide range of disease course
options: from mild cases to severe forms complicated by intestinal necrosis,
perforation, peritonitis, and sepsis [1].
RЕSULTS АND DISСUSSIОN
As a rule, the disease develops in the first two weeks of life, but in 16% of
patients it occurs immediately after birth. In practice, pediatric surgeons often
encounter enterocolitis already at the peritonitis stage, when the prognosis for
the life of patients worsens and the mortality rate reaches 70%, and with
extensive intestinal necrosis - 100%. Until recently, it was believed that NEC is
the fate of "surviving premature babies", but today this process is often
diagnosed in full-term children. Risk factors that can predispose to the
development of this disease include hypoxia, asphyxia, apnea, lung pathology,
THEORETICAL ASPECTS IN THE FORMATION OF
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hypovolemic shock, complicated labor, anhydrous period lasting more than 6
hours, congenital heart defects, intrauterine infection, prematurity, perinatal
CNS damage, "aggressive" enteral nutrition, and features of the intestinal blood
supply in newborns. Despite the polyetiological nature of the development of
NEC, the main cause of the disease is intrauterine chronic fetal hypoxia. Other
associated risk factors have a synergistic effect in the pathogenesis of the
disease [2].
Pathogenesis.
The initial stage in the development of NEC is damage to the
mucous layer of the intestinal wall, which can be complicated by ulceration,
perforation, peritonitis. The pathological process is localized in the small and /
or large intestine in the form of "scattered" foci of necrosis. Taking into account
the leading factor of pathogenesis, three variants of the course of NEC are
distinguished: hemodynamic, mixed, infectious and inflammatory. The
hemodynamic variant of the course is characterized by the presence of intestinal
ischemia as a consequence of perinatal damage to the central nervous system,
centralization of blood circulation. Inflammation indicators are slightly elevated
in the blood test. In the morphological picture, circulatory disorders are noted in
the form of plethora of the vessels of the submucosal layer, stasis of
erythrocytes, extensive foci of hemorrhage, ischemic necrosis of the mucous
membrane.
Microbiology.
The leading place in the microbiological status of newborns
is occupied by s. epidermidis, P. aeruginosa, E. coli, E. faecalis, representatives of
the genus Enterobacter. In most cases, s. epidermidis are cultured from the
umbilical wound, and the growth of the latter is also noted in cultures from the
intubation tube and oral cavity. Representatives of the genus Enterobacter give
abundant growth in cultures from the abdominal cavity, which is taken into
account when sanitizing the surgical area. In cases of no growth of
microorganisms from peritoneal effusion in purulent peritonitis, the presence of
anaerobes (C. perfringens, C. difficile) can be assumed. Thus, with C. perfringens,
the disease occurs in a fulminant form with pronounced pneumatosis of the
intestinal wall, perforation and often ends in death [3].
Differential diagnostics.
NEC should be differentiated from birth spinal
injury, cerebrovisceral syndrome, in which: 1) intestinal paresis, regurgitation
and vomiting develop earlier - on the 1st-3rd day of life, in NEC the clinical
picture unfolds on the 2nd week of life; 2) neurological symptoms prevail in the
status; 3) radiography shows only isolated paretic levels and distention of
intestinal loops; 4) neurological treatment significantly improves the condition.
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Treatment.
The choice of treatment tactics for NEC depends on the
severity of the child's condition and the stage of the process. Conservative
therapy is carried out at stages I and II of the disease, both conservative and
surgical treatment are possible at stage III, and emergency surgery is indicated
at stage IV.
Complex pre- and postoperative treatment has a great influence on a
favorable outcome of the disease, which includes:
total parenteral nutrition for 3-5 days or more depending on the severity of
the child's condition and restoration of intestinal passage;
decompression of the stomach with a nasogastric tube; infusion and
syndrome therapy to stabilize the hemostasis system and hemodynamic
parameters; the use of broad-spectrum antibiotics (third-generation
cephalosporins) in combination with aminoglycosides (amikacin) and
metronidazole; immunoreplacement therapy (Pentaglobin, immunoglobulin,
Viferon) [4].
СОNСLUSIОN
Interest in the study of necrotic enterocolitis problems does not wane. The
most relevant areas are the study of pathogenesis, the search for new diagnostic
criteria for this disease and the development of preventive measures for
patients at risk of developing necrotic enterocolitis.
References:
1. Bell m.J., shackelford P., Feigin R.D. et al. Epidemiologic and bacteriologic
evaluation of neonatal necrotizing enterocolitis. Pediatric surgery 2019; 14: 1–4.
2. Walsh m., Kleigman R. Necrotizing enterocolitis: treatment based on staging
criteria. Pediatric Am 2016; 33: 179–201.
3. Krasovskaya T.V., Kobzeva T.N. Surgery of newborns: diagnostics and
intensive care. M: Izdatel Mokeev; 2013.
4. www.ziyonet.uz
