Abstract
Background: Necrotizing enterocolitis (NEC) is a leading cause of death from gastrointestinal disease in premature infants. It has been recognized for decades as the most common life-threatening medico-surgical intestinal emergency in newborns. The overall incidence of NEC has been reducing steadily during the past few years and has become even less common in late preterm and in term infants. However, accumulating evidence over the years suggest that NEC should be considered in a broader set including these subpopulations with risk factors. The disease might be associated with short and long-term complications, prolong hospitalization, and be cost worthy. Medical treatment alone may be done with considerable success, when diagnosed early enough with mild or moderate severity. In most cases, a multidisciplinary approach is recommended as much as possible. Nevertheless, primary prevention by breastfeeding promotion and standardized formula replacement when indispensable is pertinent. Method: We present and discuss based on current reviews, a case of early onset NEC complicating sepsis in a late preterm. Results: It appears that medical management alone which is indicated for moderate NEC may be quite successful when based on broad spectrum antibiotics that cover gram negative bacteria and anaerobes, together with intensive and supportive cares. Conclusion: NEC may occur precociously in late preterm. The prompt diagnosis may be made easier by radiological exams. A multidisciplinary approach for the management of stage II or moderate NEC may be more efficient. Breastfeeding remains an effective prevention against NEC.
Highlights
Necrotizing enterocolitis (NEC) is a leading cause of death from gastrointestinal disease in premature infants
The management could be medical by broad spectrum antibiotic therapy and supportive care mainly, indicated for mild and moderate forms, while surgical treatment by laparotomy and drainage or section of the affected intestinal portion may be envisaged for stage III or severe NEC [7]
The majority of NEC occur among preterm infants between 27 and weeks of gestational age (GA), with high incidence in neonates weighing ≤ 1500g, there exist a small subset of cases among neonates ≥ weeks of GA [1, 5, 7]
Summary
NEC is the most occurring and deadly gastrointestinal disease of the preterm infant [1] It is a medico-surgical emergency with close to 15 million preterm infants affected by this condition each year, with about 11% live birth infants affected by this condition worldwide [1, 2]. During the “cross-switching phenomenon”, TLR 4 hyperactivity occurs in response to bowel colonization by microorganisms in the postnatal period [7]. This leads to deleterious effects including enhanced pro inflammatory cytokine release, mesenteric ischemia, impaired mucosal healing, necrosis and enterocyte apoptosis [8]. The various risk factors of NEC reported in the literature include prematurity, very low birth weight
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