Necrotizing enterocolitis is a disease of the intestine that occurs primarily in preterm infants. The exact causes have not yet been clearly clarified. Even if the treatment of the disease achieves ever greater success, it still occurs frequently and in not a few cases leads to death.
What is necrotizing enterocolitis?
Doctors understand necrotizing enterocolitis to be a severe intestinal disease that mainly occurs in premature infants. See phonejust for Learning Disorder Meaning.
This is an infection associated with impaired blood flow in the intestinal wall. The tissue becomes necrotic and changes. Putrefactive gases accumulate and, in the worst case, the contents of the intestine penetrate into the abdominal cavity. The affected newborns have a bloated stomach, can no longer tolerate food and may vomit bloody bile.
Statistics say that every 10th premature baby is still affected by necrotizing enterocolitis. Despite advances in medicine, the mortality rate in preterm infants is still 5-10%, depending on the infant’s birth weight and general condition, and the stage at which the disease is diagnosed.
The exact causes of the development of necrotizing enterocolitis have not yet been clarified. Physicians were able to identify numerous risk factors or circumstances that seem to favor the disease.
However, it could not be determined whether some factors have a greater influence on the development of the disease or not. The possible triggers of necrotizing enterocolitis include previous illnesses such as certain heart defects (e.g. aortic isthmus stenosis, a narrowing of the aorta).
However, conditions such as volume deficiency shock, in which severe fluid loss leads to a decrease in the amount of blood in the vessels, or respiratory distress syndrome, a lung dysfunction in newborns, are said to favor the development of necrotizing enterocolitis. This also applies to hypoglycaemia, hypothermia, low blood pressure or the insertion of a catheter through the umbilical cord vessels.
Symptoms, Ailments & Signs
The disease usually begins insidiously. Their progression is graded according to different stages. In stage I, the first signs appear in the form of unstable body temperature, a bloated abdomen that is tender to the touch, and refusal to eat. In addition, respiratory arrest occurs again and again. The child looks pale, his complexion becomes greyish and he is sleepy.
Bloody stools may occur. In stage II, the general condition worsens even more. The child hardly reacts to pain stimuli and the body cools down, arms and legs in particular feel cold. The pauses in breathing become more frequent and the heartbeat slows down. Vomiting of bilious gastric juice occurs and the amount of blood in the stool increases.
If the child no longer reacts, it must be ventilated. This condition can rapidly worsen and progress to stage III. The intestinal tissue dies, causing its contents to leak into the abdominal cavity and causing life-threatening peritonitis. There is a risk of sepsis. The abdomen is then very tense, reddish spots form on the flanks and water retention occurs. In most cases, these stages occur sequentially. However, it can also happen that the disease deteriorates dramatically from stage I to stage III within a few hours.
Diagnosis & History
Necrotizing enterocolitis can still be diagnosed in the clinic by the attending physicians.
First, a general physical examination of the premature baby takes place, together with a comprehensive blood test. In addition, imaging methods provide information about clear symptoms such as thickened intestinal walls and enlarged intestinal loops. Gas bubbles can often also be seen. If the intestinal wall is already perforated, leaked air can also be detected in the abdominal cavity.
Ultrasonography can provide similarly clear evidence of the presence of necrotizing enterocolitis. If necrotizing enterocolitis remains untreated or is recognized too late, the perforations in the intestinal wall described above occur. This allows intestinal contents to get into the abdominal cavity, which leads to sepsis and can be fatal.
In the worst case, this disease can lead to the death of the person affected. Parents and relatives in particular can react to this with psychological upsets and sometimes require psychological treatment. As a rule, those affected by this disease suffer from various complaints in the region of the stomach and intestines. This leads to bloody bowel movements and more frequent vomiting.
A bloated stomach and insufficient bowel movements can also occur and further reduce the patient’s quality of life. In many cases, patients with this disease also suffer from very pale skin and circulatory problems. If left untreated, it can also lead to peritonitis, which in the worst case can be fatal.
As a rule, this disease can be treated with the help of antibiotics. There are no complications. However, those affected are still dependent on surgical interventions or removal of the intestine and thus receive an artificial anus. This leads to considerable limitations in the everyday life of the patient. If the treatment is successful, the life expectancy of the affected person is usually not reduced.
When should you go to the doctor?
Persistent or increasing behavioral abnormalities in preterm infants are usually a cause for concern. Apathy, listlessness, or severe restlessness indicate health problems that should be investigated. A doctor is needed for refusal of food or liquid, excessive tearfulness, or insomnia. Peculiarities of the complexion, discoloration or a dull skin structure must be presented to a doctor. A doctor should be consulted in the event of sensory disturbances, hypersensitivity to touch or increased body temperature. If there is severe flatulence, blood in the stool or urine and swelling, the symptoms need to be clarified.
Vomiting, interruptions in breathing and abnormal heart rhythms must be reported to a doctor immediately. If water retention is noticed, the child is not responding appropriately to social interactions, or if there are circulatory problems, medical attention is needed. With cold limbs, a low reflex reaction, as well as the formation of spots, it is necessary to consult a doctor. Since the disease can end with the premature death of the patient if left untreated, a doctor should be consulted as soon as possible. If existing complaints increase in scope and intensity within a few hours, there is a need for action. In an acute condition, an emergency service must be alerted. At the same time, adequate first aid measures must be taken to ensure the infant’s survival.
Treatment & Therapy
If a necrotizing enterocolitis has been clearly diagnosed, the nutrition via the gastrointestinal tract must first be stopped. Meanwhile, the premature baby is supplied with all the necessary nutrients via infusions.
This measure usually has to be carried out over a period of up to ten days. The disease itself is treated with antibiotics. The blood flow in the intestinal wall can also be supported or improved with medication. If the intestinal wall has already been perforated, the affected parts of the intestine must be surgically removed. The earlier this intervention takes place, the smaller the section to be removed.
An artificial anus must be placed temporarily, which can slowly be replaced by normal bowel activity after about eight to ten days. If the disease is detected early enough and treated appropriately, the prognosis for newborns with necrotizing enterocolitis is quite favorable.
Outlook & Forecast
The prognosis of the disease depends on how quickly the clinical picture of necrotizing enterocolitis and the resulting sepsis can be recognized. It also plays a major role in the timely manner in which adequate treatment was started. The chances of recovery for those affected always depend on the severity of the disease. If sepsis can be well controlled with the right medication, the prognosis for the patient is not bad. If treated, only about 5 to 10 percent of affected newborns die.
If the disease is left untreated, about 10 to 30 percent die. If the necrosis has spread to larger sections of the intestine, the child will quickly develop short bowel syndrome. The intestine must be removed if it no longer recovers. The more intense the symptoms of the patient and the more advanced the disease, the more often an operation is necessary. However, there is always a risk that the removal of some sections of the intestine will result in the patient suffering from the so-called short bowel syndrome, which can lead to malnutrition and diarrhea. On average, about ten percent of those affected suffer from short bowel syndrome. Approximately ten percent of patients also suffer so-called strictures of the intestine as the disease progresses.
It is not yet possible to prevent necrotizing enterocolitis . Among other things, scientists are trying to protect premature babies from the disease by administering antibodies or prophylactic antibiotics. However, a proven preventive effect is not yet known.
A close observation of the premature baby in the clinic is therefore the best and only way to recognize possible symptoms in good time and to initiate therapy. In this way, progression of the disease and a potentially fatal course can be prevented.
Follow-up care for necrotizing enterocolitis is only possible to a very limited extent. It depends on the type of treatment. With drug treatment, rehabilitation is less conflict-ridden than after surgery. The age of the child and the length of stay in the neonatal intensive care unit also have an influence.
Follow-up care is initially completely inpatient. The child remains in the hospital until it can eat again and continues to gain weight. In some cases, infusions are used for this. After discharge from the hospital, regular follow-up examinations are necessary. These initially take place at relatively short intervals. If there is a positive development, these are then carried out monthly, later annually.
Rest and protection of the body are important during aftercare in your own home. Physical exertion should be avoided. It is also possible to observe whether vomiting, constipation, lack of bowel movements or anemia occur. In these cases, a doctor should be consulted. In some cases, additional antibiotics are required as follow-up care. Here is to pay attention to the correct intake. Necrotizing enterocolitis is a serious complication and can lead to long-term health problems.
You can do that yourself
Necrotizing enterocolitis represents a threatening clinical picture and must therefore be treated in intensive care. Parents of the newborn therefore quickly feel relegated to the role of spectator and left alone with their fears. It is important for both partners to ask for psychological support at an early stage and to accept the help that is offered. Fears should be discussed openly with everyone involved. Any siblings should not be left out either.
The sick newborn should be able to have contact with the parents as often as possible and, if possible, they should also take on nursing tasks themselves. The professional nursing team is usually happy to accommodate this request.
If in the course of the treatment a section of the intestine is removed and an artificial anus is created, the clinics usually offer appropriately trained staff to take care of it. Usually this so-called “anus praeter” is only a short-term solution. If there is a risk of short bowel syndrome, the further nutrition of the child and its individual needs should first and foremost be discussed with the treating doctor. If necessary, an experienced nutritional therapist will then provide further advice. In this case, it is difficult to make blanket recommendations and the individuality of each patient must be given special consideration.