Neonatal Necrotizing Enterocolitis in the Absence of Pneumatosis Intestinalis

Kliegman, Robert M.; Fanaroff, Avroy A.

doi:10.1001/archpedi.1982.03970430050014

Cited by 15 publications

(10 citation statements)

References 8 publications

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“…In a review of 44 cases, Yu and co-workers found evidence of bowel perforation (free air) on the initial abdominal radiograph in eleven of fifteen NEC infants [4]. Kliegman had similiar results with 46% showing perforation at the time of the first film or during the first 12 hours after diagnosis [5]. In our series only 3 patients had radiographic evidence of perforation on the first abdominal radiograph and nearly one half of the perforations occurred between 20 and 30 h after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of bowel perforation in necrotizing enterocolitis

et al. 1987

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The most severe complication of necrotizing enterocolitis (NEC) is bowel perforation. Identification of neonates at high risk for perforation and optimization of radiologic imaging to identify bowel perforation are necessary to reduce the high mortality rate associated with this catastrophic event. One hundred and fifty-five cases of NEC were seen at our institution during a 5.5-year period. Nineteen (12%) progressed to perforation. A review of surgical findings, autopsy results and radiographs from these patients shows only 63% had radiographic evidence of free air in the peritoneal cavity at the time of perforation. Twenty-one percent had radiographic evidence of ascites but no pneumoperitoneum, and 16% had neither free air nor ascites. Thus purely radiographic criteria for bowel perforation in NEC are imprecise, and paracentesis is mandatory in NEC patients with ascites or clinical findings indicative of peritonitis. Timing of radiographic studies and site of bowel involvement are also important. Seventy-nine percent of perforations occurred by 30 h from confirmation of diagnosis (by clinical or radiographic criteria). Surgery or autopsy revealed involvement of the ileo-cecal region in 89% of cases with the actual site of perforation occurring in this area in 58% of patients.

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Section: Discussionmentioning

confidence: 99%

Analysis of bowel perforation in necrotizing enterocolitis

et al. 1987

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“…The mean day of onset of necrotizing enterocolitis is day 12 of life. [106][107][108][109][110][111][112][113] The median day is the seventh day of life, while the most common day (mode) was the third day of life. Infants may present with disease from the first to the 99th day of their hospitalization.…”

mentioning

confidence: 99%

Neonatal necrotizing enterocolitis: Pathogenesis, classification, and spectrum of illness

Kliegman¹,

Walsh²

1987

Current Problems in Pediatrics

285

233

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“…Da eine NEC auch ohne die typischen radiologischen Zeiehen auftreten kann [13], wurde bei allen Kindern, die aufgrund einer Darmperforation in der Neonatalperiode operiert werden muBten, eine histologische Untersuchung der erkrankten Darrnabschnitte durchgeffihrt. Wfihrend bei den Patienten mit einem Geburtsgewicht fiber 1 500 g der fibliche Nahrungsaufbau vom 1.…”

Section: Methodeunclassified

“…Die 3 Patienten, die in der 4. und 5 Lebenswoche erkrankten, erhielten vor dem 12. Hinzu kommt eine immunologische Unreife der Darmschleimhaut mit erh6hter Permeabilit/it ftir pathogener Erreger [13,28]. Unter einer sehr schnellen Steigerung der oralen Nahrungsmenge wurde eine zunehmende Inzidenz nekrotisierender Enterokolitiden beschrieben [9].…”

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Nekrotisierende Enterokolitis (NEC): Symptomatologie, Diagnostik und therapeutische Konsequenzen

Harms

Lüdtke

Lepsien

et al. 1994

Langenbecks Arch Chir

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Within a 6-year period ten patients with necrotizing enterocolitis (grade II-III; Bell) have been treated at the University Hospital, Göttingen. The following NEC incidences were calculated: birth weight < 1000 g: 2.4% (3/123); 1000-1500 g: 0.6% (2/308); 1501-2000 g: 0.7% (3/436); > 3000 g: approximately 0.006% (2/30,000 live births). In all patients onset of necrotizing enterocolitis (NEC) was associated with typical clinical symptoms such as abdominal distension, feeding problems, bloody stools. Only four out of ten patients had positive blood tests of various inflammatory parameters when diagnosed (C-reactive protein, neutrophil count, I/T-ratio). However, increased CRP levels were observed in all patients during the course of the disease (maximum levels: day 2-4 after diagnosis). During primarily conservative therapeutic management only one out of ten patients developed bowel perforation (day 6 after diagnosis) and immediate surgical treatment was carried out. In addition, in three patients who acquired strictures with obstruction of the colon, elective surgery was performed at a postnatal age of 51-77 days. All patients survived NEC without longterm sequelae. We conclude that a primarily conservative therapeutic regimen-whenever perforation and gangrene are absent-may be an alternative to early surgical intervention in NEC.

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Neonatal Necrotizing Enterocolitis in the Absence of Pneumatosis Intestinalis

Cited by 15 publications

References 8 publications

Analysis of bowel perforation in necrotizing enterocolitis

Analysis of bowel perforation in necrotizing enterocolitis

Neonatal necrotizing enterocolitis: Pathogenesis, classification, and spectrum of illness

Nekrotisierende Enterokolitis (NEC): Symptomatologie, Diagnostik und therapeutische Konsequenzen

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