Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants.
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.
Harms
K
K
Department of Pediatrics, University of Göttingen, Germany.
Michalski
S
S
Speer
Ch
Ch
Lüdtke
F E
FE
Lepsien
G
G
D004761:Enterocolitis, Pseudomembranous / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology* / Q000517:prevention & control; D011027:Pneumoperitoneum / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome