Management of necrotizing enterocolitis in newborns
- Richard J Schanler, MD
Richard J Schanler, MD
- Hofstra Northwell School of Medicine
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 . Although early recognition and aggressive treatment of this disorder have 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 management of NEC depends upon the severity of illness as classified by the Bell staging criteria (table 1). Medical management is appropriate in most cases. However, infants with advanced NEC and bowel perforation (stage IIIB) require surgical intervention. Care for the infant with (or suspected) NEC is provided by a multi-disciplinary team, which includes surgical consultation that assists the neonatology team in the evaluation and management of the infant, and decides if and when surgery is needed.
The treatment and outcome of NEC will be reviewed here. The pathology, pathogenesis, clinical features, diagnosis, and prevention of this disorder are discussed separately. (See "Pathology and pathogenesis of necrotizing enterocolitis in newborns" and "Clinical features and diagnosis of necrotizing enterocolitis in newborns" and "Prevention of necrotizing enterocolitis in newborns".)
Overview — Medical management should be initiated promptly when necrotizing enterocolitis (NEC) is suspected. It consists of the following:
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- MEDICAL MANAGEMENT
- Supportive care
- Antibiotic therapy
- Laboratory monitoring
- Radiographic monitoring
- SURGICAL MANAGEMENT
- - Primary peritoneal drainage
- - Laparotomy
- - Comparison of procedures
- - Our approach
- Acute complications
- Late complications
- - Stricture formation
- - Short bowel syndrome
- - Rare complications
- Long-term outcome
- - Growth and neurodevelopment
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS