Clinical Management of Necrotizing Enterocolitis

Abstract

After completing this article, readers should be able to: 1. List the major risk factor for developing necrotizing enterocolitis (NEC). 2. Describe the presenting symptoms and physical findings of NEC. 3. Describe the initial steps in stabilizing an infant who has NEC. 4. Delineate the current recommendations for surgical intervention in NEC. Necrotizing enterocolitis (NEC) is the most common intestinal emergency in the preterm infant, occurring in 1% to 5% of patients admitted to the neonatal intensive care unit (NICU) and in 1 to 3 per 1,000 live births. Data from the National Center for Health Statistics and individual institutions suggest an incidence of 1,200 to 9,600 cases per year in the United States that result in more than 2,600 deaths annually. The incidence of NEC correlates strongly with the degree of prematurity. Only a handful of patients were reported as having NEC in the 1960s when very low-birthweight (VLBW) infants did not survive long enough to acquire the disease. The incidence of NEC is lower in countries that have decreased rates of prematurity. The routine use of both antenatal steroids and prophylactic surfactant has resulted in the survival of greater numbers of VLBW babies, and these extremely preterm infants present the greatest challenge in the clinical management of NEC. Over the past decade, advances in neonatal management have decreased the mortality and morbidity associated with most conditions of prematurity, as demonstrated by a recent report of the incidence of chronic lung disease during the postsurfactant administration years of 1996 to 1998. VLBW patients who had birthweights of 801 to 900 g had only a 25% incidence of chronic lung disease; the incidence was only 15% among those weighing 901 to 1,000 g. In comparison, a study in 1975 of mechanically ventilated VLBW patients reported survival in only 32%, all of whom had bronchopulmonary …