neonatal necrotizing enterocolitis

Digital cases

 Case 226: Parietal pneumatosis in neonatal necrotic enterocolitis

Definition: Neonatal necrotizing enterocolitis is a disease affecting predominantly premature infants, is a leading cause of morbidity and mortality in neonatal intensive care units.

Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and death. The pathophysiology is poorly understood.

Prevailing evidence suggests that NEC is due to an inappropriate inflammatory response of the immature gut to some undefined insult.

Prognosis

The mortality rate (15%-25%) for affected infants has not changed appreciably in 30 years. Many infants with NEC recover uneventfully with medical therapy and have long-term outcomes similar to unaffected infants of matched gestational age. Infants with progressive disease requiring surgical intervention suffer almost all of the mortality and morbidity. Of these, 30%-40% will die of their disease and most of the remainder will develop long-term neurodevelopmental and gastrointestinal morbidity.

Recent randomized trials suggest that the choice of operation does not influence patient outcome.

Predisposing factors

 prematurity
 enteral feeding
 infection

Complications

 colonic stricture
 ileocolic fistula (19304467)

• Intestinal fistula is a rare complication in necrotizing enterocolitis (NEC) and is typically associated with a colonic stricture.

References

 Henry MC, Moss LR. Necrotizing Enterocolitis. Annu Rev Med. 2008 Sep 25. PMID: 18817461

 Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol. 2003 Jan-Feb;6(1):6-23. PMID: 12424605

 Hsueh W, Caplan MS, Tan X, MacKendrick W, Gonzalez-Crussi F. Necrotizing enterocolitis of the newborn: pathogenetic concepts in perspective. Pediatr Dev Pathol. 1998 Jan-Feb;1(1):2-16. PMID: 10463267