Necrotizing Enterocolitis for USMLE

Necrotizing Enterocolitis is the most common cause of GIT problems in preterm. It is a mucosal or even trans-mucosal necrosis which can often times cause perforation. Incidence and fatality increases with prematurity. Pathogenesis is related to three underlying factors.
First factor of necortizing enterocolitis is intestinal ischemia, enteral nutrition, and finally bacterial colonization. Enteral Nutrition of the preterm infant is still premature therefore there is decreased motility and function. Since it is not being absorbed there is increased amount of bacteria. Therefore aggressive enteral feeding of preterm infant can predispose to necrotizing enterocolitis. Therefore in preterm you don't want to overfeed them. Human milk tends to be better formula milk. Most likely becuase protective affects of IgA.
Bacterial growth in newborn with Necrotizing Entercolitis is due to immature barrier and immature immune system. Also the pH is still high and therefore it is difficult to tackle some of the bacteria. Common organisms are the coagulase nigative staph, e.coli, klebsiella, clostridium perfringens, rotavirus. Antibiotics for more than 5 days also increases likelihood.
Term infants don't get necrotizing entercolitis, but if they have congenital heart disease, perinatal asphyxia, respiratory condition, polycythemia can predispose to necrotizing enterocolitis. Indomethacin is associated with this because it causes contraction of splanchnic vasculature.
CLINICAL FINDINGS
Initially patient will be doing okay until the first or second week, however, it can be up to 30 days later. The greater the prematurity the later in gestational age will be seen. Presentation begins with decreasing feed tolerance, distention and vomiting and diarrhea. Diarrhea is generally bloody.
Pateitns with necrotizing entercolitis can develop sepsis, DIC, and perforation.
Management of Necrotizing entercolitis is to first do an abdominal x-ray to confirm the diagnosis. If pneumoperitoneum is suspected the patient needs to be left lateral decubitus position and you can see air in the abdomen. Pneumatosis intestinalis which is gas in the small intestines. There will also be dilated loops. Abdominal ultrasound will show the same picture, but there is also fluid collection and there will be bowel wall thickness. Hepatic ultrasound may show portal venous gas. Labs of necrotizing entercolitis can't confirm necrotizing entercolitis, but it can help rule out other causes and establish a baseline value. If there is severe neutropenia less than 1,500 than that is a poor prognostic sign. Coagulation is suspected DIC, and serum markers and electrolytes which can suggest necrosis and sepsis. Respiratory problems associated with Arterial Blood Gas. Sepsis workup is related to blood culture, stool culture, and CSF culture. Stool culture you may want to look for occult blood. Differential Diagnosis is obstruction, rotavirus, but this will be more clustered. Cow milk protein allergy. Spontaneous intestinal performation may mimic necrotizing entercolitis, however, there will be a bluish discoloration rather than reddish discoloration.
Management of necrotizing entercolitis is supportive. This includes bowel rest by giving TPN, Nasogastric suctioning, If there is Cardiovascular or respiratory issue than that also needs to be addressed. IV Fluids must correct for loss of fluids.
Anti-Biotics you need to go broad spectrum. Empirical treatment you have every hospital has its own protocol. Pediatric Surgeon needs to be invovled especially if there is any sign of perforation. They can't really handle surgery. Laparatory of necrotic bowel and resection, but this can lead to short bowel syndrome. Primary Peritoneal Drainage at bedside they can make a stab wound at McBurney's Point. Preferred if they are Extremely Low Birth Weight. Complications of necrotizing entercolitis can be divided into Acute and Chronic. Sepsis, DIC, CVS, Resp, Metabolic acidosis and hyoglycemia are the acute complications. Chronic complications may be strictures and worsening symptoms. If they undergo surgery there may be Short Bowel Syndrome and the infant can't absorb enough nutrients and they need to be on TPN. Generally, 50% have not sequelae, but mortality is between 20-40%. The more pre-term they are, then the higher the mortality.
Prevention of necrotizing entercolitis is breastfeeding and if they are Very Low Birth Weight then minimize enteral feeding, but there needs to be judicious volume advancement. Probiotics also has shown some benefits in treating necrotizing entercolitis.

[@lesliesanchez6607]

Great explanation! My baby 👶past away for interstitial intericolitis and it's a great explanation for mothers who need to know what it is.

[@Smile56329]

I am very sorry for your loss. Just know your baby is in heaven.

[@marisaquintana9943]

I wish we had known about this. We just lost our grandson to NEC.

[@chrisdom7731]

Thank you so much :D very clearly explained

[@ricardofrausto8061]

Great video! Could you tell me what program are you using?

[@reemali4364]

thank you

[@claudiojulioinostrozafeliu3983]

thank u , great video!

[@MultiMusik4]

thank you!

[@yonelagamnca285]

So good, thank you.

[@dark1tai]

thanks

[@udaykiran9866]

Thank you very much Please add bells staging too

[@esthergathoni4654]

Yeah

[@areenshahid823]

Kindly make a video on volvulus and hirschprung disease

[@rameezguroo7457]

Superb lecture,thanku sir

[@thestudyspot]

So nice of you

[@nouraalshehri5580]

Perfect

[@fakhrialdeenalhakemi1536]

Nice

[@adiimimi]

Thank you so much

[@thestudyspot]

You're most welcome

[@katlegomoeng9750]

Good staff

[@AhmedSaleh-ic6lv]

Amazing video doctor, but I have a simple question will infants with NEC have high or low glucose ? Bcz in the investigations u said high glucose then in the complications u said low glucose could be an acute complications

[@still.singing]

I had NEC. My glucose was low.

[@flaminmongrel6955]

well it should be low due to decreased carbohydrates and fat absorption but idk if there a high blood glucose in response to that cause body would start breaking down the glycogen and fat to compensate?

[@damimalinki9901]

Thank you

[@thestudyspot]

You're welcome

[@lisainger6751]

No blood transfusion either, ever, this is very important.

[@geaj4214]

I know that this is a year old but could you explain why you said no transfusion please?

[@lisainger6751]

@@geaj4214 When you give a premature baby packed cells they block the babies tiny capillaries. Packed red cells get stuck together when they are stored and cannot enter the blood vessels and the bowel dies. They operate and remove the part of the bowel.Then they give them another one because they need to top up the cells and the baby dies. My grandson was given one at 6pm, by 10 pm he was too late to save.

[@sparklerlife3193]

My newborn premature (35 weeks pregnancy weeks) niece (was born healthy 2,2kg, no breathing problem) but suddenly just died because of NEC, just 4 days life. she started to have breathing problem at night of 2nd day.. then 3rd day, her stomach got really big and bluish.. then 4rth day she is gone.. her doctor gave her blood tranfussion and antibiotics.. I don't know if those treatment was right or not.. because my sister and her baby are living in small city in Asia and hospital is not so good for premature baby and also because corona pandemic, it's not easy to find better hospital.. The problem is I didn't know the blood tranfusion can make NEC more worse.. how come? and how to avoid NEC and to do the treatment? it was very quick happening to my niece.. in just 4 days.. very quick and doctors there don't know what to do.. unfortunately.

[@shanx7706]

I’m sorry this happened to you

[@johnnydumont4340]

Omg God . Same.with my son . He was only 7 weeks old

[@xDomglmao]

What do you exactly mean by "clustered rotavirus"?

[@areenshahid823]

Excellent

[@thestudyspot]

Thank you so much 😀

[@doityourself-diyartfun1562]

Doctor a baby with nec needs to be on quarantine our can be with with other babies ?

[@lisainger6751]

the condition isn't communicable

[@DoctorSK69]

Damn this video still works in 2022😂

[@antisnowflake1721]

Does the adding of fortifications to breast milk increase incidence?

[@lisainger6751]

Yes it does, My grandson was given cow's milk at 7 weeks and with a blood transfusion that is what killed him. He was 13 weeks premature and perfect. No cow's milk ever for premature babies, ever, breast milk is all the baby needs.

[@doityourself-diyartfun1562]

My daughter hah a lot blood transfusions:( She had nec and remove 22/17 cm intestine. Is a baby with nec stay in quarantine?

[@jasonjabra]

the video is great , but did you said "acidity as an increase of pH " by mistake?

[@blightrunner1645]

he said there isn't much acidity as yet so pH is still high

[@ariellalima7229]

The stomach does not produce enough gastric acid yet, which makes the baby prone to high pH in the GIT. Acidemia, of course, is a different issue.

[@powelishxx5020]

Thanks but my book said it’s never found in the 1st week only 2-4weeks after birth,! So?

[@nawafh.9708]

The same thing: Peak incidence: 2nd-4th week after birth (not during the first week!)

[@rohitshedage6215]

My baby is admitted in hospital this same symptoms are present in the baby but doctor said that this not a necrotizing electrolyte plz help me about that as early as possible

[@thestudyspot]

So sorry to hear about your child. Unfortunately, I'm not a pediatrician and this video is for students studying for USMLE. I recommend you discuss this with local specialist. God Bless.

[@geaj4214]

How is baby doing? I hope well.

[@itswhatyoumakeit6950]

Pretty sure human milk is more than just a bit better than formula.

[@JoeKampeza-sn6gn]

Nice work..improve handwriting

[@itsssmenil7287]

you talk too fast.

[@hariskhan-xj4wk]

run with slow speed

[@fundiwawatu]

thanks