Necrotizing Enterocolitis in Children

Necrotizing Enterocolitis in Children
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About Necrotizing Enterocolitis

When babies are born prematurely, a lot of their organs are not totally established. This puts them at risk for a variety of diseases within the first weeks of life.

One of these illness is necrotizing enterocolitis (nek-roh-TIE-zing en-ter-oh-coh-LIE-tis), the most common and serious digestive disease amongst preemies. Necrotizing enterocolitis (NEC) occurs when tissue in the little or big intestinal tract is injured or begins to pass away off. This causes the intestinal tract to end up being inflamed or, in uncommon cases, establish a hole (perforation).

When this takes place, the intestinal tract can not hold waste, so bacteria and other waste products go through the intestine and go into the baby’s blood stream or abdominal cavity. This can make a baby extremely ill, possibly causing a life-threatening infection.

NEC usually affects babies born before 32 weeks pregnancy, but it can take place in full-term infants who have illness, like a heart problem. Babies with NEC typically develop it within the first 2 to 4 weeks of life.

Necrotizing enterocolitis (NEC) is an issue with the intestines. “Enterocolitis” (pronounced ent-air-oh-co-LITE-iss) implies inflamed small intestine and colon. “Necrotizing” (pronounced nek-roh-TIE-zing) means it causes tissue death. With NEC the intestinal tracts get irritated and infected by bacteria. The infection can cause part of the intestinal tract to die.

What Causes NEC?

The specific cause of NEC is unknown, but professionals think that different factors may contribute. These consist of:

  • an underdeveloped intestinal tract
  • insufficient oxygen or blood flow to the intestinal tract at birth (typically the outcome of a hard delivery)
  • injury to the intestinal tract lining
  • heavy development of bacteria in the intestine that erodes the intestinal tract wall
  • formula feeding (babies who are breastfed have a lower risk of developing NEC)

NEC sometimes appears to happen in “epidemics,” affecting a number of infants in the same nursery. Although this may be coincidental, it recommends that the disease could sometimes spread out from one baby to another, regardless of the truth that all nurseries have extremely strict precautions to prevent the spread of infection.

Necrotizing Enterocolitis in Children

Signs and Symptoms

The symptoms of NEC can be just like those of other digestion conditions, and may vary in seriousness from baby to baby. Typical symptoms consist of:

  • a swollen, red, or tender belly (abdominal area)
  • not feeding well
  • food staying in the stomach longer than anticipated
  • constipation
  • diarrhea and/or dark or bloody stools (poop)
  • being less active
  • a low or unsteady body temperature level
  • seldom, green vomit (containing bile)

Other signs of NEC can consist of apnea (routine drop in breathing), bradycardia (slowed heart rate), and hypotension (low blood pressure). More severe cases might have fluid in the abdominal cavity that shows up on X-ray, peritonitis (infection of the membrane lining the abdomen), or shock.

Diagnosis

In babies with symptoms of NEC, a medical diagnosis can be verified if an abnormal gas pattern shows up on an X-ray. This appears like a bubbly or streaky appearance of gas in the walls of the intestine.

In severe cases, air gets away from the intestinal tract and appears in the large veins of the liver or the abdominal cavity. A doctor might place a needle into the abdominal cavity to withdraw fluid to figure out whether there is a hole in the intestines.

Treatment and Care

All babies with NEC need to be treated with medicines and therapy. About one third may need surgery to fix the intestinal tract.

After diagnosis, treatment starts instantly and consists of:

  • temporarily stopping all feedings
  • nasogastric drainage (inserting a tube through the nose into the stomach to remove air and fluid from the stomach and intestinal tract)
  • intravenous (IV) fluids for fluid replacement and nutrition
  • antibiotics to treat or avoid infection
  • regular evaluations and X-rays of the abdomen
  • an assessment with a pediatric cosmetic surgeon to talk about surgery, if needed

The baby’s poop likewise will be watched for blood and the baby’s abdominal girth (belly size) will be inspected routinely. If the intestine perforates or there is an infection in the abdominal cavity, the belly will swell. If a baby’s belly is so swollen that it hinders breathing, additional oxygen or a breathing device (ventilator) will assist the baby breathe. Likewise, blood samples are required to try to find bacteria and to make sure the baby has not established anemia (a reduction in red cell).

After reacting to treatment, a baby can be back on routine feedings after a week. Sometimes feedings are kept a bit longer and antibiotics continue for another 10-14 days. When feedings begin once again, breast milk is advised. Breast milk is useful for babies with NEC because it is easily digested, supports the growth of healthy bacteria in the digestive tract, and improves a baby’s resistance– which is specifically important for a preemie with an immature immune system.

For women who cannot breastfeed or offer enough breast milk, physicians may recommend providing the baby pasteurized human breast milk from a milk bank, which is thought about a safe option.

Some babies whose condition worsens or who have a perforation in the intestinal tract, will require exploratory surgery. During this procedure, physicians take a look at the abdominal cavity to look for a hole in the intestine or to get rid of any dead or dying intestinal tissue. If needed, medical professionals will set up a 2nd surgery to remove a diseased area of the intestinal tract. In many cases after this elimination, the healthy intestinal tract can be stitched back together. Other times, especially if the baby is extremely ill or a large section of the intestine was gotten rid of, an ostomy will be done. During an ostomy, cosmetic surgeons bring an area of the intestine to an opening on the abdominal area (stoma) so that stool can securely exit the body.

Most babies who establish NEC recuperate completely and do not have further feeding issues. Sometimes, the bowel may be scarred or narrowed, or intestinal obstruction may take place. If so, more surgery is required.

Malabsorption (when the bowel can’t take in nutrients normally) can be a lasting problem from NEC. It’s more typical in babies who had part of their intestinal tract eliminated. A baby with malabsorption may need nutrition provided directly into a vein until the intestine heals all right to endure regular feeding.

Taking care of Your Child

If your baby has NEC, it’s regular to feel scared or anxious. And not being able to feed your baby can be frustrating– babies are so little, it simply does not feel right to stop feedings or remove that valuable bonding time. However that might be the best thing for your baby during treatment. And remember, there’s a good chance that your baby will be back on regular feedings soon.

In the meantime, ask a member of your care team what you can do to look after and bond with your baby. There are ways you can assist. Members of your care team are eager to support parents of preemies, in addition to the preemies themselves, on the course to recovery.

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