Neonates necrotizing enterocolitis

The possible association of indometacin tocolysis with neonatal necrotizing enterocolitis has been the subject of a case-control study (53). All cases of proven necrotizing enterocolitis were ascertained and four controls for each case were randomly identified. During 18 months there were 24 cases of necrotizing enterocolitis. Indometacin as a single tocolytic agent was not associated with necrotizing enterocolitis (OR = 1.0, 95% Cl = 0.2, 4.8). 

Caplan, M.S., and. Tilling, T. (2001) The Role of Polyunsaturated Fatty Acid Supplementation in Intestinal Inflammation and Neonatal Necrotizing Enterocolitis, Lipids 36,1053-1057. 

Lucas A, Cole TJ. 1990. Breast milk and neonatal necrotizing enterocolitis. Lancet 336 1519-1523. 

Beneficial effects of probiotic consumption in the prevention and treatment of several gastrointestinal diseases, such as inflammatory bowel diseases, antibiotic associated-diarrhoea, neonatal necrotizing enterocolitis, irritahle bowel syndrome, Helicobacter pylori infection, as well as food allergies and intolerances, have been clearly assessed (Sanders et al. 2013). Furthermore, probiotics are effective in reducing cholesterol levels and lowering blood pressure (Kumar et al. 2012). However, molecular mechanisms underlying strain-specific probiotic action and the identity of effector molecules (peptidoglycan, teichoic acid, cell surface polysaccharides, extracellular proteins) still remain to be fully elucidated. 

Octreotide has been used in premature neonates for closure of enterocutaneous fistulae complicating necrotizing enterocolitis. Two cases of oxygen desaturation have been reported (12). The authors suggested that the effect may relate to pre-existing hyaline membrane disease. 

Gram-negative septicemia possibly related to oral Gastrografin has also been reported in a premature neonate with necrotizing enterocolitis (48). 

Premature neonates are reported to have a relative deficiency of vitamin E at birth, which has been associated with hemolytic anemia (16). Since there was an increased incidence of necrotizing enterocolitis when oral tocopherol was given to such infants (7,8,17,18), parenteral tocopherol was for a while recommended for use in very ill neonates (19,20). 

Johnson L, Bowen P, Herman N. The relationship of prolonged elevation of serum vitamin E levels to neonatal bacterial sepsis (SEP) and necrotizing enterocolitis (NAC). Pediatr Res 1983 17 319A. 

Cudd A, Pauly T H 1987 Necrotizing enterocolitis in two equine neonates. Compendium on Continuing Education for the Practicing Veterinarian 9 88-92 Dabareiner R M, Snyder J R, White N A et al 1995 Microvascular permeability and endothelial cell morphology associated with low-flow ischemia/reperfusion injury in the equine jejunum. American Journal of Veterinary Research 56 639-648 Dart A J, Snyder J R, Spier S J et al 1992 Ionized calcium concentration in horses with surgically managed gastrointestinal disease 147 cases (1988-1990). Journal of the American Veterinary Medical Association 201 1244-1248... 

Guthrie SO, Gordon PV, Thomas V, et al. Necrotizing enterocolitis among neonates in the United States. J Perinatal 2003 23 278-285. 

Neonatal Intestinal Obstruction I High Obstruction 2 Low Obstruction 14 Necrotizing Enterocolitis 29 Pneumoperitoneum 34... 

Disorders of the intestinal tract in the neonatal period usually present with abdominal distension and dilatation of the bowel. However, not all intestinal dilatations represent obstruction. Infants with medical disorders such as sepsis, electrolyte imbalance or necrotizing enterocolitis may present ileus characterized by uniform dilatation of the bowel to the level of the rectum. Also, infants on continuous positive airways pressure may swallow an excessive amount of air and exhibit important intestinal dilatation. This dilatation must be distinguished from mechanical obstruction, because the treatment is completely different. The differentiation between these two categories can usually be made on the basis of clinical history, laboratory tests, and appropriate radiographs (Hernanz-SCHULMAN 1999). 

Fig. 1.35a,b. Necrotizing enterocolitis, a Photograph of a 3-week-old premature neonate showing important abdominal distension, b Plain abdominal radiograph shows diffuse nonspecific gaseous distension of the bowel loops... 

Horton KK (2005) Pathophysiology and current management of necrotizing enterocolitis. Neonatal Netw 24 37-46 Hurth PJ, Meyer JS, Shaaban A (2002) Ultrasound of a torsed ovary characteristic gray-scale appearance despite normal arterial and venous flow on Doppler. Pediatr Radiol 32 586-588... 

Morrison SC, Reid JR, Harrison M et al (2004) Systemic arterial pneumatosis in a neonate with necrotizing enterocolitis. Pediatr Radiol 34 337-339... 

There are factors in maternal milk that maintain neonatal gastrointestinal integrity. For example, breast milk has been shown to be protective against necrotizing enterocolitis (NEC), a serious disease characterized by ulceration and necrosis of the neonatal gastrointestinal tract. In a prospective multicenter study involving 926 preterm infants, Lucas and Cole (1) demonstrated that the incidence of NEC was 6-10 times more common in neonates fed conventional infant formula than in neonates fed breast milk. Additional evidence for the protective effect of human milk was provided by Schanler et al. (2), who reported that the incidence of NEC in a randomized clinical trial involving 171 preterm infants was inversely related to the quantity of human milk fed. 

Laje P, Halaby L, Adzick NS, Stanley CA. Necrotizing enterocolitis in neonates receiving octreotide for the management of congenital hyperinsulinism. Pediatr Diabetes 2010 11(2) 142-7. 

Scott KP, Gratz SW, Sheridan PO, Flint HJ, Duncan SH. The influence of diet on the gut microbiota. Pharmacol Res. 2013 69 52-60. Deshpande G, Rao S, Patole S, Bulsara M. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics. 2010 125 921-930. 

Premature infants who require ligation of a patent ductus arteriosus (PDA) or who present with necrotizing enterocolitis (NEC) often weigh less than 1 kg and are not on conventional ventilators, thus often cannot be moved from the neonatal intensive care imit and cannot tolerate an anesthesia machine or a volatile anesthetic. 

Bifidobacteria, when administered together with lactobacilli immediately after birth, were shown to promote the colonization of neonatal piglet gut with a beneficial commensal microbiota. This treatment limited pathogen load in premature neonatal piglets, and thus lowered colonization by Clostridium perfringens and reduced the incidence and severity of necrotizing enterocolitis (Siggers... 

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