Necrotising
Enterocolitis
Anne Aspin 2010
What is it?
 Infection of the mucosal lining of the
bowel
 Lactobacilli
 Clostridium
 Unknown
Who does it effect?








Maternal factors
prematurity
Hypoxic episodes
Cardiac anomaly
Exchange transfusion
Umbilical line near mesenteric artery
High osmolarity feeding
Increasing feeds quickly
Signs and symptoms








Change in behaviour
Subtle signs
Lethargy
Increasing naso-gastric aspirates
Labile temperature, labile blood sugars
Vomiting, bile later
Blood in stools
Abdominal distension
Later








Mottled, grey, capillary refill <4 secs
Apnoeic
Bradycardia
Oxygen requirement
Abdominal tenderness
Oedema
Dilated abdominal veins, dilated loops of bowel
Flare around umbilicus
Even later







Thrombocytopenia
Raised CRP
Pneumoperitoneum
Collapse, ventilation
Abdominal drain
Surgery, stoma’s
Short bowel
Grading




Grade 1
Grade 2
Grade 3
Grade 4
What to do





Large ng tube, aspirate and free drainage
Nil by mouth
IVI, Antibiotics
Blood sugar monitoring
Sepsis screen. Blood gas, FBC, U/E’s,
Blood cultures
 Urine MC/S, CXR, AXR
Surgical intervention
 When perforated
 When conservative treatment failing
 Strictures, adhesions
Stoma
 Immediate post-op
 Stoma care
 Stomal complications
Enteral feeding
 Feeding
 Long term TPN
 Short bowel
References








Abad-Sinden A and Sutphen J (2003). Nutritional Management of
Pediatric Short Bowel Syndrome. Practical Gastroenterology. Series 12:
28-48
Agwu J and Narchi H (2005). In a Preterm Infant, Does Blood Transfusion
Increase the Risk of Necrotising Enterocolitis? Archives Disease in
Childhood, Fetal Neonatal Ed 90: 102-103
Andorsky D, Lund D, Lillehei C et al (2001). Nutritional and other
Postoperative Management of Neonates with Short Bowel Syndrome
Correlates with Clinical Outcomes. Journal of Pediatrics 139: 260-270
Bednarek F, Weisberger S,Richardson D et al (1998). Variations in blood
transfusions among newborn intensive care units.
In: Agwu J and Narchi H (2005) In a Preterm Infant, Does Blood
Transfusion
Increase the Risk of Necrotising Enterocolitis?
Archives Disease in Childhood, Fetal Neonatal Ed 90: 102-103
Bell M (1978). Neonatal Necrotising Enterocolitis. New England Journal of
Medicine. 298:281 – 82
Bentley D, Lifschitz C, Lawson M (2001). Pediatric Gastroenterology and
Clinical Nutrition. ReMedica Publishing. London. UK
Boxwell G (2000). Neonatal Intensive Care Nursing. Routledge. London
Boyd S (1997). Necrotising Enterocolitis. Neonatal Network Vol3, No 2
References









Candy D, Davies G,Ross E (2001). Clinical Paediatrics and Child Health. WB
Saunders. Edinburgh
Castanon M, Prat J, Saura L, Gomez L, Tarrado X, Iriondo M, Morales L (2006).
Nutritional and Surgical Management of Short Bowel Syndrome. Our last six
patient’s experience. Cir Pediatric. 19 (3):151-5
Chauhan M, Henderson G, Mc Guire W (2008) Enetral feeding for very low birth
weight infants:reducing the risk of necrotizing enterocolitis. Archives of Disease in
Childhood-Fetal and Neonatal Edition. 93:F162- F166
Davis B, Abel G, Puntis J et al (1999). Limited Ileal resection in Infancy: The Long
Term Consequences. Journal of Paediatric Surgery. 34:583-587
Ehrlich PF, Sato TT, Short BL, Hartman GE. (2001). Outcomes of perforated
necrotizing enterocolitis in the very low birth weight neonate may be independent
of the type of surgical treatment. American Surgery. 67: 752-756
Ein S, Marshall D, Girvan D. (1977). Peritoneal drainage under local anaesthesia
for perforation from necrotizing enterocolitis.
In: Basani L, Rao S and Simmer K (2007). The Cochrane Collaboration.
The Cochrane Library. http:/www.thecochranelibrary.com
Wiley Publishers.
Gardner V, Walton J, Chessel L et al (2003). A Case Study Utilising an Enteral
Refeeding Technique in a Premative Infant with Short Bowel Syndrome.
Advanced Neonatal Care. 3: 258-271
Gibbs G (1988) Learning by Doing. A guide to Teaching and Learning Methods.
Further Education Unit. Oxford Polytechnic. Oxford
References







Guillet R, Stoll BJ, Cotton CM, Gantz M, McDonald S, Poole W, Phelps
D.(2006). Association of H2 blocker therapy and higher incidence of
Necrotizing Enterocolitis in very low birth weight infants. Paediatric 117:
e137-142
Hebra A and Ross A (1996) Necrotising Enterocolitis
In: Boxwell G (2000) Neonatal Intensive Care Nursing.
Routledge. London
Kir P, H, Whyte R, Anderson C et al (2006). The Premature Infants in
Need of Reconstructive (low) Versus Liberal (high) Transfusion Threshold
for Extremely Low Birth Weight Infants. Journal of Paediatrics 149: 301307
Kosloske A (1997). The Epidemiology and Pathogenisis of Necrotising
Enterocolitis Seminars in Neonatology 2:; 231-238
Langer J (1996). Gastroschisis and Omphalocele. Seminars in Paediatric
Surgery 5: 124-128
Lawrence G, Bates J, Gaul A (1982). Pathogenisis of neonatal necrotizing
enterocolitis
In: Kosloske A.(2003) .Necrotising Enterocolitis
In: Puri P (2003) Neonatal Surgery. Arnold. New York
Lebenthal A and Lebenthal E (1999). The Ontology of the small intestinal
epithelium. Journal of Parenteral Enteral Nutrition. 23, S5
References










Lin P & Stoll B (2006). Necrotising Enterocolitis. Lancet 368: 1271-1283
Mally P, Golombek S, Mishra R, Nigam S, Mohandas K, Depalmha H,
LaGamma E (2006) Association of Necrotising Enterocolitis with Packed
Red Blood Cell Transfusions in Stable, Growing, Premature Neonates.
American Journal Perinatology. 23:451-951
Martin G, Wallace L & Sigalet D (2004) Glucagon – Like Peptide – 2
Induces Intestinal Adaptation in Perinatally Fed Rats with Short Bowel
Syndrome.
American Journal Physiology Gastrointestinal Liver Physiology. 286:
G964-G972
Mc Grady G, Retting P, Istre G, Jason J, Holman R, Evati B (1987). An
outbreak of Necrotising Enterocolitis Association with Transfusions of
Packed Red Blood Cells.American Journal of Epidemiology Vol 126, No
6:1165-1172
McGuire W and Anthony M(2003). Donor Human Milk Versus Formula
For Preventing Necrotising Enterocolitis in Paternal Infants: Systematic
Review.
Archives of Disease in Childhood. Fetal Neonatal Ed. 88: F11-14
Nadler E, Upperman J, Ford H (2001) Controversies in the management
of necrotizing enterocolitis.
Surgical Infections 2 (2):113-9
National Electronic Library for Health. www.nelh.nhs.uk
References







Newell S (1996) Gastrointestinal function and its ontogeny:How should
we feed the preterm infants Seminars inNeonatology. 1, 60
Nursing and Midwifery council (2004) The NMC code of conduct:
standards for conduct, performance an ethics. Publication Department,
Nursing and midwifery council, London
Omari T, Barnett C, Beningon M et al (2002) Mechanisms of Gastro
oesophageal Reflux in Preterm and Term Infants with Reflux Disease. Gut
51:475-479
Puri P (2003) 2nd Ed Neonatal Surgery. Arnold. London
Richardson L, Banerjee S & Rabe H (2006) What is the Evidence on the
Practise of Mucous Fistula Refeeding in Neonates with Short Bowel
Syndrome? Journal of Paediatric Gastroenterology and Nutrition 43: 267270
Romero R, Garcia-Casillas M, Matute J, Barrientos G, Zamora E, Megias
A et al (2005) A role of peritoneal drainage in very low birth weight with
enterocolitis.
In: Basani L, Rao S and Simmer K (2007). The Cochrane
Collaboration.The Cochrane Library. http:/www.thecochranelibrary.com