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Necrotizing enterocolitis in the neonatal intensive care unit. A review and management guidelines.
This review covers clinical and laboratory findings, pathophysiology, and management of NEC. The term neonatal necrotizing enterocolitis (NEC) is used to describe a disease spectrum ranging from simple mucosal disruption and inflammation to frank mucosal and submucosal necrosis. An increased incidence of NEC has been reported in preterm infants receiving formula that does not contain lactoferrin. Feeding intolerance (incomplete bowel transition) may be an early finding of NEC; it is usually associated with abdominal distention, a soft, lumpy, and distended abdomen, and occasionally a palpable abdominal mass. Laboratory findings are often unremarkable; although some newborns with NEC have an elevated WBC count and inflammatory markers. Abdominal distension and a soft, lumpy, and distended abdomen are most characteristic of NEC. Plain radiographs are useful in infants with NEC because they demonstrate small bowel dilation and thickening consistent with NEC. Abdominal ultrasound and computed tomography can be used in cases of severe NEC. Parenteral nutrition, hydration, antibiotic therapy, and surgical management are the mainstays of the treatment of NEC. The recommended antibiotic therapy consists of third-generation cephalosporin for less than 7 days, followed by vancomycin. Patients who receive antibiotic therapy and surgical intervention have decreased incidence of
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