Synonyms
Necrotizing Enterocolitis, NEK, NEC
Definition
Necrotizing enterocolitis is an inflammation of the intestinal wall that occurs mainly in premature infants (birth weight <1500g). It can lead to bacterial colonization of the intestine and to the death of individual sections (necrosis) of the intestine. It is the most common cause of acute gastrointestinal diseases (acute abdomen) in premature babies.
The causes of necrotizing enterocolitis have not yet been reliably clarified. It is known, however, that a reduced supply (ischemia) causes bacteria to migrate through the intestinal wall of the terminal ileum and the ascending colon. These bacteria cause inflammation of the intestinal wall, which leads to water deposits and bleeding in the intestinal wall and the death of individual intestinal sections (necroses). Ultimately, this is how bacteria enter the abdominal cavity and can lead to inflammation of the peritoneum (peritonitis) and then to a generalized infection of the blood (sepsis) with a shock. Possible risk factors for the development of necrotizing enterocolitis are, for example, pulselessness (asphyxia), epidural anesthesia during birth (epidural), catheterization of the umbilical cord vessels, an increased number of red blood cells (polyglobules) and shock.
Symptoms
The main symptoms of necrotizing enterocolitis are dilated, rigid intestinal loops and a bloated, painful abdomen. Hardly any bowel sounds can be detected during the examination. Food intake is problematic because the children cannot keep food in their bodies and have to vomit.
In addition, the bowel movement shows blood admixtures or there is no bowel movement at all. Due to the spreading infection in the abdominal cavity (peritonitis), redness may be visible on the flanks. If the infection continues to spread, the general condition of the child decreases (sepsis). The children are usually sleepy, breathe less well or not at all (apnea) and have a very low heart rate (bradycardia). In addition, a pale, pale gray skin color is often noticeable.
Diagnosis
Since necrotizing enterocolitis is an inflammation, the blood values show increased inflammation values, increased lactate values and electrolyte disorders. A necrotizing enterocolitis can be well shown in an x-ray of the abdomen. Here, dilated intestinal loops and air bubbles in the thickened intestinal wall (pneumatosis intestinalis) caused by the bacteria can be seen.
These gas inclusions can also be found in the intestinal veins and the portal vein (V. porta). In addition, free fluid and air in the abdomen can also be found in the X-ray image due to a possible intestinal perforation. The thickened intestinal walls and air bubbles can also be partially detected by ultrasound (sonography).
