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Clinical features and diagnosis of necrotizing enterocolitis in newborns

Author
Richard J Schanler, MD
Section Editor
Steven A Abrams, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn infant. It is a disorder characterized by ischemic necrosis of the intestinal mucosa, which is associated with inflammation, invasion of enteric gas forming organisms, and dissection of gas into the muscularis and portal venous system [1]. Although early recognition and aggressive treatment of this disorder has improved clinical outcomes, NEC accounts for substantial long-term morbidity in survivors of neonatal intensive care, particularly in premature very low birth weight infants (birth weight below 1500 g).

The clinical features and diagnosis of NEC are reviewed here. The pathology, pathogenesis, management, and prevention of this disorder are discussed separately. (See "Pathology and pathogenesis of necrotizing enterocolitis in newborns" and "Management of necrotizing enterocolitis in newborns" and "Prevention of necrotizing enterocolitis in newborns".)

EPIDEMIOLOGY

Necrotizing enterocolitis (NEC) occurs in 1 to 3 per 1000 live births and 1 to 7.7 percent of admissions to neonatal intensive care units (NICUs) [2].

Preterm infants — The incidence decreases with increasing gestational age (GA) and birth weight (BW), and is about 6 to 7 percent in very low birth weight (VLBW) infants (BW less than 1500 g) [3-5].

This was illustrated in one study of VLBW infants born between 1999 and 2001 from the National Institute of Child Health and Human Development (NICHD) neonatal network cohort [3]. The overall rate of NEC was about 7 percent. Rates were inversely related to BW as follows:

               

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Literature review current through: Nov 2016. | This topic last updated: Thu Feb 18 00:00:00 GMT 2016.
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References
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  1. Neu J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996; 43:409.
  2. Kosloske AM. Epidemiology of necrotizing enterocolitis. Acta Paediatr Suppl 1994; 396:2.
  3. Horbar JD, Badger GJ, Carpenter JH, et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002; 110:143.
  4. Sankaran K, Puckett B, Lee DS, et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units. J Pediatr Gastroenterol Nutr 2004; 39:366.
  5. Lee SK, McMillan DD, Ohlsson A, et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000; 106:1070.
  6. Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. J Pediatr Surg 2010; 45:1391.
  7. Yee WH, Soraisham AS, Shah VS, et al. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 2012; 129:e298.
  8. Holman RC, Stoll BJ, Clarke MJ, Glass RI. The epidemiology of necrotizing enterocolitis infant mortality in the United States. Am J Public Health 1997; 87:2026.
  9. Wiswell TE, Robertson CF, Jones TA, Tuttle DJ. Necrotizing enterocolitis in full-term infants. A case-control study. Am J Dis Child 1988; 142:532.
  10. Polin RA, Pollack PF, Barlow B, et al. Necrotizing enterocolitis in term infants. J Pediatr 1976; 89:460.
  11. Ostlie DJ, Spilde TL, St Peter SD, et al. Necrotizing enterocolitis in full-term infants. J Pediatr Surg 2003; 38:1039.
  12. Lambert DK, Christensen RD, Henry E, et al. Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol 2007; 27:437.
  13. Short SS, Papillon S, Berel D, et al. Late onset of necrotizing enterocolitis in the full-term infant is associated with increased mortality: results from a two-center analysis. J Pediatr Surg 2014; 49:950.
  14. Kliegman RM, Walker WA, Yolken RH. Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis. Pediatr Res 1993; 34:701.
  15. Uauy RD, Fanaroff AA, Korones SB, et al. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1991; 119:630.
  16. Kliegman RM, Fanaroff AA. Necrotizing enterocolitis. N Engl J Med 1984; 310:1093.
  17. Walsh MC, Kliegman RM, Fanaroff AA. Necrotizing enterocolitis: a practitioner's perspective. Pediatr Rev 1988; 9:219.
  18. Yu VY, Tudehope DI, Gill GJ. Neonatal necrotizing enterocolitis: 1. Clinical aspects. Med J Aust 1977; 1:685.
  19. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187:1.
  20. Gordon P, Christensen R, Weitkamp JH, Maheshwari A. Mapping the New World of Necrotizing Enterocolitis (NEC): Review and Opinion. EJ Neonatol Res 2012; 2:145.
  21. Buonomo C. The radiology of necrotizing enterocolitis. Radiol Clin North Am 1999; 37:1187.
  22. Kliegman RM, Hack M, Jones P, Fanaroff AA. Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants. Absence of identifiable risk factors. J Pediatr 1982; 100:440.
  23. Sharma R, Tepas JJ 3rd, Hudak ML, et al. Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis. J Pediatr Surg 2005; 40:371.
  24. Sharma R, Hudak ML, Tepas JJ 3rd, et al. Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis. J Perinatol 2006; 26:342.
  25. Bömelburg T, von Lengerke HJ. Sonographic findings in infants with suspected necrotizing enterocolitis. Eur J Radiol 1992; 15:149.
  26. Silva CT, Daneman A, Navarro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 2007; 37:274.
  27. Bohnhorst B. Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2013; 98:F445.
  28. Muchantef K, Epelman M, Darge K, et al. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol 2013; 43:1444.
  29. Garbi-Goutel A, Brévaut-Malaty V, Panuel M, et al. Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. J Pediatr Surg 2014; 49:508.
  30. Faingold R, Daneman A, Tomlinson G, et al. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology 2005; 235:587.
  31. Kenton AB, O'Donovan D, Cass DL, et al. Severe thrombocytopenia predicts outcome in neonates with necrotizing enterocolitis. J Perinatol 2005; 25:14.
  32. Hällström M, Koivisto AM, Janas M, Tammela O. Laboratory parameters predictive of developing necrotizing enterocolitis in infants born before 33 weeks of gestation. J Pediatr Surg 2006; 41:792.
  33. Christensen RD, Yoder BA, Baer VL, et al. Early-Onset Neutropenia in Small-for-Gestational-Age Infants. Pediatrics 2015; 136:e1259.
  34. Pourcyrous M, Korones SB, Yang W, et al. C-reactive protein in the diagnosis, management, and prognosis of neonatal necrotizing enterocolitis. Pediatrics 2005; 116:1064.
  35. Bizzarro MJ, Ehrenkranz RA, Gallagher PG. Concurrent bloodstream infections in infants with necrotizing enterocolitis. J Pediatr 2014; 164:61.
  36. Kosloske AM, Goldthorn JF. Paracentesis as an aid to the diagnosis of intestinal gangrene: experience in 50 infants and children. Arch Surg 1982; 117:571.
  37. Abramo TJ, Evans JS, Kokomoor FW, Kantak AD. Occult blood in stools and necrotizing enterocolitis. Is there a relationship? Am J Dis Child 1988; 142:451.
  38. Cheu HW, Brown DR, Rowe MI. Breath hydrogen excretion as a screening test for the early diagnosis of necrotizing enterocolitis. Am J Dis Child 1989; 143:156.
  39. Book LS, Herbst JJ, Jung AL. Carbohydrate malabsorption in necrotizing enterocolitis. Pediatrics 1976; 57:201.
  40. Gordon PV, Swanson JR, Attridge JT, Clark R. Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria? J Perinatol 2007; 27:661.
  41. Riffaud L, Ndikumana R, Azzis O, Cadre B. Glial heterotopia of the face. J Pediatr Surg 2008; 43:e1.
  42. Cordova J, Sriram S, Patton T, et al. Manifestations of Cow's-Milk Protein Intolerance in Preterm Infants. J Pediatr Gastroenterol Nutr 2016; 62:140.