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Necrotising Enterocolitis

Necrotising Enterocolitis. Anne Aspin 2010. What is it?. Infection of the mucosal lining of the bowel Lactobacilli Clostridium Unknown. Who does it effect?. Maternal factors prematurity Hypoxic episodes Cardiac anomaly Exchange transfusion Umbilical line near mesenteric artery

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Necrotising Enterocolitis

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  1. Necrotising Enterocolitis Anne Aspin 2010

  2. What is it? • Infection of the mucosal lining of the bowel • Lactobacilli • Clostridium • Unknown

  3. Who does it effect? • Maternal factors • prematurity • Hypoxic episodes • Cardiac anomaly • Exchange transfusion • Umbilical line near mesenteric artery • High osmolarity feeding • Increasing feeds quickly

  4. Signs and symptoms • Change in behaviour • Subtle signs • Lethargy • Increasing naso-gastric aspirates • Labile temperature, labile blood sugars • Vomiting, bile later • Blood in stools • Abdominal distension

  5. Later • Mottled, grey, capillary refill <4 secs • Apnoeic • Bradycardia • Oxygen requirement • Abdominal tenderness • Oedema • Dilated abdominal veins, dilated loops of bowel • Flare around umbilicus

  6. Even later • Thrombocytopenia • Raised CRP • Pneumoperitoneum • Collapse, ventilation • Abdominal drain • Surgery, stoma’s • Short bowel

  7. Grading • Grade 1 • Grade 2 • Grade 3 • Grade 4

  8. What to do • Large ng tube, aspirate and free drainage • Nil by mouth • IVI, Antibiotics • Blood sugar monitoring • Sepsis screen. Blood gas, FBC, U/E’s, Blood cultures • Urine MC/S, CXR, AXR

  9. Surgical intervention • When perforated • When conservative treatment failing • Strictures, adhesions

  10. Stoma • Immediate post-op • Stoma care • Stomal complications

  11. Enteral feeding • Feeding • Long term TPN • Short bowel

  12. References • Abad-Sinden A and Sutphen J (2003). Nutritional Management of Pediatric Short Bowel Syndrome. Practical Gastroenterology. Series 12: 28-48 • Agwu J and Narchi H (2005). In a Preterm Infant, Does Blood Transfusion Increase the Risk of Necrotising Enterocolitis? Archives Disease in Childhood, Fetal Neonatal Ed 90: 102-103 • Andorsky D, Lund D, Lillehei C et al (2001). Nutritional and other Postoperative Management of Neonates with Short Bowel Syndrome Correlates with Clinical Outcomes. Journal of Pediatrics 139: 260-270 • Bednarek F, Weisberger S,Richardson D et al (1998). Variations in blood transfusions among newborn intensive care units. In: Agwu J and Narchi H (2005) In a Preterm Infant, Does Blood Transfusion Increase the Risk of Necrotising Enterocolitis? Archives Disease in Childhood, Fetal Neonatal Ed 90: 102-103 • Bell M (1978). Neonatal Necrotising Enterocolitis. New England Journal of Medicine. 298:281 – 82 • Bentley D, Lifschitz C, Lawson M (2001). Pediatric Gastroenterology and Clinical Nutrition. ReMedica Publishing. London. UK • Boxwell G (2000). Neonatal Intensive Care Nursing. Routledge. London • Boyd S (1997). Necrotising Enterocolitis. Neonatal Network Vol3, No 2

  13. References • Candy D, Davies G,Ross E (2001). Clinical Paediatrics and Child Health.WB Saunders. Edinburgh • Castanon M, Prat J, Saura L, Gomez L, Tarrado X, Iriondo M, Morales L (2006). • Nutritional and Surgical Management of Short Bowel Syndrome. Our last six patient’s experience. Cir Pediatric. 19 (3):151-5 • Chauhan M, Henderson G, Mc Guire W (2008) Enetral feeding for very low birth weight infants:reducing the risk of necrotizing enterocolitis. Archives of Disease in Childhood-Fetal and Neonatal Edition. 93:F162- F166 • Davis B, Abel G, Puntis J et al (1999). Limited Ileal resection in Infancy: The Long Term Consequences. Journal of PaediatricSurgery. 34:583-587 • Ehrlich PF, Sato TT, Short BL, Hartman GE. (2001). Outcomes of perforated necrotizing enterocolitis in the very low birth weight neonate may be independent of the type of surgical treatment. American Surgery. 67: 752-756 • Ein S, Marshall D, Girvan D. (1977). Peritoneal drainage under local anaesthesia for perforation from necrotizing enterocolitis. In: Basani L, Rao S and Simmer K (2007). The Cochrane Collaboration. The Cochrane Library. http:/www.thecochranelibrary.com Wiley Publishers. • Gardner V, Walton J, Chessel L et al (2003). A Case Study Utilising an Enteral Refeeding Technique in a Premative Infant with Short Bowel Syndrome. Advanced Neonatal Care. 3: 258-271 • Gibbs G (1988) Learning by Doing. A guide to Teaching and Learning Methods. Further Education Unit. Oxford Polytechnic. Oxford

  14. References • Guillet R, Stoll BJ, Cotton CM, Gantz M, McDonald S, Poole W, Phelps D.(2006). Association of H2 blocker therapy and higher incidence of Necrotizing Enterocolitis in very low birth weight infants. Paediatric 117: e137-142 • Hebra A and Ross A (1996) Necrotising Enterocolitis In: Boxwell G (2000) Neonatal Intensive Care Nursing. Routledge. London • Kir P, H, Whyte R, Anderson C et al (2006). The Premature Infants in Need of Reconstructive (low) Versus Liberal (high) Transfusion Threshold for Extremely Low Birth Weight Infants. Journal of Paediatrics 149: 301-307 • Kosloske A (1997). The Epidemiology and Pathogenisis of Necrotising Enterocolitis Seminars in Neonatology 2:; 231-238 • Langer J (1996). Gastroschisis and Omphalocele. Seminars in Paediatric Surgery 5: 124-128 • Lawrence G, Bates J, Gaul A (1982). Pathogenisis of neonatal necrotizing enterocolitis In: Kosloske A.(2003) .Necrotising Enterocolitis In: Puri P (2003) Neonatal Surgery.Arnold. New York • Lebenthal A and Lebenthal E (1999). The Ontology of the small intestinal epithelium. Journal of Parenteral Enteral Nutrition. 23, S5

  15. References • Lin P & Stoll B (2006). Necrotising Enterocolitis. Lancet 368: 1271-1283 • Mally P, Golombek S, Mishra R, Nigam S, Mohandas K, Depalmha H, LaGamma E (2006) Association of Necrotising Enterocolitis with Packed Red Blood Cell Transfusions in Stable, Growing, Premature Neonates. American Journal Perinatology. 23:451-951 • Martin G, Wallace L & Sigalet D (2004) Glucagon – Like Peptide – 2 Induces Intestinal Adaptation in Perinatally Fed Rats with Short Bowel Syndrome. • American Journal Physiology Gastrointestinal Liver Physiology. 286: G964-G972 • Mc Grady G, Retting P, Istre G, Jason J, Holman R, Evati B (1987). An outbreak of Necrotising Enterocolitis Association with Transfusions of Packed Red Blood Cells.American Journal of Epidemiology Vol 126, No 6:1165-1172 • McGuire W and Anthony M(2003). Donor Human Milk Versus Formula For Preventing Necrotising Enterocolitis in Paternal Infants: Systematic Review. • Archives of Disease in Childhood. Fetal Neonatal Ed. 88: F11-14 • Nadler E, Upperman J, Ford H (2001) Controversies in the management of necrotizing enterocolitis. • Surgical Infections 2 (2):113-9 • National Electronic Library for Health. www.nelh.nhs.uk

  16. References • Newell S (1996) Gastrointestinal function and its ontogeny:How should we feed the preterm infants Seminars inNeonatology. 1, 60 • Nursing and Midwifery council (2004) The NMC code of conduct: standards for conduct, performance an ethics. Publication Department, Nursing and midwifery council, London • Omari T, Barnett C, Beningon M et al (2002) Mechanisms of Gastro oesophageal Reflux in Preterm and Term Infants with Reflux Disease. Gut 51:475-479 • Puri P (2003) 2nd Ed Neonatal Surgery. Arnold. London • Richardson L, Banerjee S & Rabe H (2006) What is the Evidence on the Practise of Mucous Fistula Refeeding in Neonates with Short Bowel Syndrome? Journal of Paediatric Gastroenterology and Nutrition 43: 267-270 • Romero R, Garcia-Casillas M, Matute J, Barrientos G, Zamora E, Megias A et al (2005) A role of peritoneal drainage in very low birth weight with enterocolitis. • In: Basani L, Rao S and Simmer K (2007). The Cochrane Collaboration.The Cochrane Library. http:/www.thecochranelibrary.com

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