How Is This Treated?Will My Child Have DevelopmentalDelays?

There has been minimal research on the longlasting effects of Necrotizing Enterocolitis.However, research has shown that surgicalpatients have an increased risk of havingneurodevelopmental and neuromotor delays.Infants at 18 to 20 months will be below the10th percentile in weight, height and headcircumference. The average weight of infants at18 to 20 months is 9.73 kg+1.40, and headcircumference is 46.0+2.0 cm. Infants whounderwent surgery were more likely to bediagnosed with Cerebral Palsy, deafness and beblind. However, it was a very low percent.Chiildren were found to have poor cognitiveabilities and academic difficulties at the schoolage.Support Groups AndResources

http://kidshealth.org/parent/medical/digestive/nec.html#http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/hrnewborn/nec.htmlhttp://www.experienceproject.com/groups/Have-Necrotizing-Enterocolitis/92972http://www.mdjunction.com/necrotizing-enterocolitishttp://www.pediatricsurgerymd.org/AM/Template.cfm?Section=List_Of_Conditions&TEMPLATE=/CM/ContentDisplay.cfm&ContentID=1580

Necrotizing EnterocolitisEverything You Need To Know

Nonsurgical Treatment

• Withhold oral feedings for 24 to 48 hours ifsuspected asphyxia at birth•Breast feeding baby is preferred because of itspassive immunity•Probiotics- improve intestinal microbial balance•Nasogastric tube placement to decompress theinfant’s abdomen•Administration of IV antibiotics through a centralvenous access•Replace oral feedings with parenteral fluids, whichare IV fluids•Abdominal radiograph every 4-6 hours duringacute phase for monitoringSurgical Treatment

•Surgery is performed when there is free visibleair on an abdominal radiograph•During surgery the physician will resect thenecrotic, or dead, portion of the bowel•An ileostomy will be placed initially, which is anartificial opening of the ileum through theabdominal wall•There will be a reanastomosis of the bowel, orreconnection, performed at a later datePrognosis

More than 75% of infants survive this disease• Those who survive may develop short gut• syndrome, fat malabsorption, failure to thrive or• colonic strictures

What Is NEC? What Are The Signs/Symptoms? Who Is At Risk?•Necrotizing Enterocolitis in an inflammatorybowel disease that mostly appears withpreterm and high-risk infants.•The etiology of this disease is indeterminate,however most infants that acquire this illnesshave three common factors that appear to playa role in its’ development.1) Intestinal ischemia- compromised ordecreased blood supply to intestines.2) Pathogenic bacteria- bacteria that causesdisease states.3) Substrate- Baby or infant formula•Mucosal cells line the bowel walls.•When there is minimal to no blood supply,these cells die and therefore cannot secreteprotective and lubricating mucus.•The unprotected bowel is susceptible andsubject to intestinal bacteria, which invadesdamaged areas causing intestinalpneumatosis.

Term and Preterm babies present with differentsigns and symptomsTerm•Presents with necrotizing enterocolitis at anearlier age• Appears within 1-3 days or as late as onemonth•Infants who appear with this conditionimmediately after birth usually have otherpredisposing conditions such as heart diseaseor metabolic abnormalities•Bilious vomiting•Gastric aspirate•Bloody stools•Abdominal distention•Pneumatosis intestinalis•Free abdominal airPretermDevelop the disease several weeks after birth•Usually coincides with enteral feedings orafter blood transfusions•Occurs rapidly with children who formula feed•Feeding intolerance for several days

•Premature infants•Infants who weigh less than 1000 g at birth•Formula fed infants• Infants in a nursery where there is an outbreakpresent•Infants with blood transfusions•Infants with a Patent Ductus Arteriosus•Term infants with congenital heart disease•Males and females are at equal risk•No difference based on raceHow Is NEC Diagnosed?-Abdominal Ultrasonography- can beperformed at the bedside in a hospital and isnoninvasive•Anteroposterior Abdominal RadiographicStudy•Laboratory studies including:•White Blood Cell Count: To identify if aninfection is present•Red Blood Cell Count: Decreased hematocritdue to blood in vomit or stool•Platelet Count: Want to make sure that theblood is clotting•Blood Culture: Recommended before startingantibiotic therapy to rule out other possiblediagnosis•Arterial Blood Gas: Determines the need forrespiratory support