All are true about necrotizing enterocolitis except
Necrotizing Enterocolitis Necrotizing enterocolitis (NEC) occurs among smaller premature infants, often those less than 32 weeks. The clinical picture mimics neonatal septicemia because of the presence of abdominal distension, apnea, bradycardia, instability of temperature, cyanosis and lethargy. NEC is believed to result from interaction of several factors such as gut immaturity, mucosal injury due to hypoxia-ischemia, milk feeding and infection. Antenatal steroids and breastfeeding protect against NEC. Delaying enteral feeding does not prevent NEC. The illness usually develops after the first week of life. The course may be very fulminant with death occurring in a few hours, moality rate being around 40-50%. Clinical manifestations may be described in three stages: Stage 1. Suspected NEC: Unstable temperature, apnea, bradycardia, lethargy, mild abdominal distension, vomiting. Frank or occult, blood may be present in stools. X-ray shows mild intestinal distension. Stage 2. Clinical signs as similar to stage 1. Bowel sounds are diminished with or without abdominal tenderness. Pneumatosis intestinalis (gas in intestinal wall) and dilatation of intestines are seen on abdominal X-ray. Stage 3. In addition to the above, the infant is severely sick with hemodynamic instability. There are frank signs of peritonitis with abdominal wall redness. Pneumoperitoneum may occur due to intestinal perforation. Management Oral feeding should be withheld. A nasogastric tube is inseed to relieve distension and to aspirate stomach contents. Fluids and electrolytes in adequate quantities should be administered. Parenteral nutrition may be administered. Shock is managed by replacement of fluids and the use of vasopressor agents. Sequelae Intestinal strictures may develop in survivors. These manifest with bloody stools, vomiting and abdominal distention. Shoened bowel leads to malabsorption. Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 165
Common among term infants
Delaying enteral feeding does not prevent NEC
Usually develops after the first week of life
Intestinal strictures may develop in survivors
New born infants