Recommended
More Related Content
Similar to NEC avery's.pdf
Similar to NEC avery's.pdf (20)
Recently uploaded
Recently uploaded (20)
NEC avery's.pdf
- 1. 254 Gastrointestinal Bleeding See Table 43.1. NECROTIZING ENTEROCOLITIS □ Necrotizing enterocolitis (NEC) most common gastroin- testinal (GI) emergency in premature infants □ Clinical features □ Incidence, ∼12% of infants born at 1500 g, 30% mor- tality □ Postnatal age of onset and incidence inversely related to birth weight and gestational age □ 90% of infants with NEC premature □ Term, late preterm infants infrequently develop NEC; risk factors (associated with bowel ischemia) include intrauterine growth restriction (IUGR) and small for gestational age (SGA), birth asphyxia, congenital heart disease, gastroschisis, polycythemia, hypoglycemia, sepsis, exchange transfusion, ± umbilical lines □ Can occur in epidemics □ Occurs more frequently in African-American infants than white infants □ More common following initiation of enteral feeds □ Breast milk and established feeding guidelines—protec- tive factors □ 50% require surgery □ Predictor of neurodevelopmental morbidity □ Positive blood cultures in one-third □ Likely multiple risk factors—bowel ischemia, immaturity of immune system, enteral feeding □ Clinical presentation □ Lethargy, apnea, abdominal distention, erythema, de- creased bowel sounds, metabolic acidosis from lactate accumulation, peaceful tachypnea due to abdominal distention and metabolic acidosis, poor perfusion with delayed capillary refill □ Diagnosis □ Suspect with clinical features; laboratory values can re- veal neutropenia, thrombocytopenia, hyponatremia. □ Abdominal x-ray—can reveal fixed loop, stacking of loops, pneumatosis, portal venous air, perforation □ Treatment □ NPO, decompress GI tract with Replogle tube, fluid resus- citation,avoiddopamine(canworsenbowelnecrosisfrom vasoconstriction),broad-spectrumantibiotics,respiratory support if apneic, surgical resection of necrotic bowel SHORT BOWEL SYNDROME □ Occurs following bowel resection to treat NEC (most com- mon), midgut volvulus, omphalocele, aganglionosis, je- junal or ileal atresia, gastroschisis □ Most frequent cause of intestinal failure in neonates □ Clinical features depend on length of remaining bowel, location of lost bowel □ Complications □ Malabsorption of nutrients □ Gastric hypersecretion □ Small bowel bacterial overgrowth □ Intestinal adaptation difficulties □ Cholestatic liver disease typically from chronic use of parenteral nutrition □ Catheter-related complications □ Enterocolitis □ Management □ Parenteral nutrition to supply adequate calories □ H2 blockers or proton pump inhibitors to suppress acid secretion □ Intermittent treatment with antibiotics for bacterial overgrowth □ Enteral feeds to help with intestinal growth and adapta- tion—small volumes of elemental formula with medi- um-chain triglycerides □ If missing ileocecal valve at high risk for diarrhea, fat and vitamin B12 malabsorption, need vitamin B12 sup- plementation Acquired Disorders of the Gastrointestinal Tract REBECCA ABELL and MEGAN E. GABEL 43 Table 43.1 Causes of Gastrointestinal (GI) Bleeding in the Neonate Upper GI Bleeding Lower GI Bleeding Swallowed maternal blood Milk protein allergy, allergic colitis Vitamin K deficiency Hirschsprung disease Stress gastritis or ulcer Necrotizing enterocolitis Acid-Peptic Disease Intussusception Vascular anomaly Gastrointestinal duplication Coagulopathy Duodenal web Mallory-Weiss tear Anal fissure Bowel obstruction Coagulopathy Milk protein allergy Volvulus Infectious colitis Meckel diverticulum Presentation of Upper GI Bleeding Presentation of Lower GI Bleeding Hematemesis Bright red blood in the stool Coffee ground emesis Tarry stools Melena