A case of successful comprehensive treatment of necrotizing enterocolitis in a newborn child

Abstract

Necrotizing enterocolitis is an inflammatory disease caused by infection and hypoxic–ischemic damage of the intestinal mucosa, which leads to generalization with the development of a systemic inflammatory response. The pathogenetic mechanisms leading to intestinal wall damage are ischemia and pain. Therefore, the use of central neuraxial blocks, which provide the analgesic effect and preganglionic blockade of the sympathetic nervous system, is pathogenetically justified.
 The aim of the work is to acquaint practitioners with the case of successful comprehensive treatment using neuraxial blocks in a newborn with necrotizing enterocolitis.
 Materials and methods. The child was treated at the Department of Anesthesiology and Intensive Care for Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using hospital equipment.
 Results. A child was operated due to suspected intestinal perforation and pneumoperitoneum. It was found that throughout the small and large intestines had multiple hemorrhages and air bubbles in the subserosa, but no perforation sites were found. Subsequently, the child underwent conservative treatment with antibacterial therapy according to the de-escalation principle, antifungal therapy, intravenous immunoglobulins, total parenteral nutrition. In addition to this standard treatment, the child underwent caudal-epidural blocks twice a day for a week in the postoperative period for effective analgesia, improvement of microcirculation and splanchnic blood flow.
 Conclusions. Surgical intervention performed on a newborn child with the second stage of necrotizing enterocolitis (intestinal pneumatosis), when its perforation could not be excluded, did not significantly affect the course of the disease, so the positive outcome can be considered the result of successful comprehensive intensive care. In our opinion, the decisive factor that influenced the positive treatment outcomes (prevention of perforation and peritonitis) was the effect of neuraxial caudal epidural blocks, which contributed to the improvement of microcirculation in the splanchnic area, elimination of intestinal ischemia and effective anesthesia.