Notwendigkeit der operativen Behandlung bei NEC?

Hp, Hümmer; Mang, Kristina; Klein, Paula; Schück, R.

doi:10.1055/s-2008-1042549

Cited by 3 publications

(3 citation statements)

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“…Different opinions abound regarding the optimum time for surgical intervention in manifest NEC. Although 23% (3/13) of all patients in the acute phase in our hospital required surgical treatment, other colleagues report early surgery in 31 to 83% of cases (2, [12][13][14][15]. The frequency of surgical treatment in pediatric surgical centres is of necessity higher, since many patients are transferred to such centres due to progressive symptoms.…”

Section: Discussionmentioning

confidence: 84%

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants

et al. 1994

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From January 1986 to December 1992, 13 patients with necrotizing enterocolitis (NEC) (Grade II‐III; Bell) were treated. The incidence was highest in the very immature infants with birth weight < 1000 g: 6/148 (4%). From onset, NEC was associated with clinical symptoms such as abdominal distension, bloody stools, retained gastric contents and septicemia. Indications of inflammation were seen in only 6 out of 13 patients at the time of diagnosis. No complications were seen in 10 patients during the acute phase. Two infants developed a bowel perforation and another one a gangrene. Immediate surgery was performed. In three other infants, elective surgery was performed because of colonic strictures. Twelve (92%) patients survived NEC. Five other VLBW infants developed spontaneous perforations of the bowel. The clinical presentation, laboratory and radiological findings differed greatly from those with NEC. Four infants survived. A primarily conservative therapeutic regime with close cooperation between the surgeon and pediatrician may be an alternative to early surgical intervention in NEC.

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Section: Discussionmentioning

confidence: 84%

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants

et al. 1994

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“…W/ihrend in unserer Klinik nur einer yon 10 Patienten in der akuten Krankheitsphase operiert werden muBte, ermittelten andere Arbeitsgruppen eine Frfihoperation in 31-65 % der F/ille [3,5,10,18,21]. W/ihrend in unserer Klinik nur einer yon 10 Patienten in der akuten Krankheitsphase operiert werden muBte, ermittelten andere Arbeitsgruppen eine Frfihoperation in 31-65 % der F/ille [3,5,10,18,21].…”

Section: Diskussionunclassified

“…Daneben stellen eine klinische Verschlechterung [1,3,11,21,25], persistierende Darmdilatationen mit stehenden Schlingen [10,21], portale Gasblase [1,25], persistierende Azidosen [4,25], Thrombozytopenien [21,26], anhaltende rektale Blutungen [1], Bauchwanderythemata [1, 10, 2J[], abdominelle Abwehrspannungen [10,11] sowie fixierte abdominelle Tumoren [16] relative Indikationen dar. Die Mortalit/it der operierten Kinder lag zwischen 18 und 50 % [10,11,16,18,21,25] und bei den Patienten mit einem Geburtsgewicht unter 1000 g sogar zwischen 40 und 50 % [18, 23, 251. Zur Entlastung des Dfinndarms wurde von einer Arbeitsgruppe auch die Meinung vertreten, bei jeder NEC groBzfigig und frfihzeitig die Indikation zum Anlegen eines hohen Anus praeter zu stellen [22]. Unserer Ansicht nach kann diese Empfehlung grundsritzlich nicht gelten, denn durch die Narkose und Laparatomie k6nnen zusritzliche Risiken ffir die sehr kleinen Frfihgeborenen entstehen.…”

Section: Diskussionunclassified

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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Necrotizing enterocolitis in very-low-birth-weight infants

et al. 1992

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Notwendigkeit der operativen Behandlung bei NEC?

Abstract: Based on the experience with 57 neonates with NEC, the significance of diagnostic methods (especially ultrasonography, paracentesis, intraoperative photometry) for treatment and results is discussed.

Cited by 3 publications

References 1 publication

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants

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

Necrotizing enterocolitis in very-low-birth-weight infants

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