In infants, the most common gastrointestinal medical emergency is necrotizing enterocolitis or NEC. NEC is a life-threatening disorder which is caused by inflammation and damage to the intestines. The mucosa of the intestines can undergo necrosis or damage and can even become perforated, causing the spillage of intestinal contents into the abdominal cavity, leading to peritonitis. This disease, in most cases, affects the proximal ascending colon and the terminal ileum.
Necrotizing enterocolitis is caused by many factors, such as ischemia, inflammatory mediators and infections. In some infants, gram negative bacteria, gram positive bacteria, viruses and fungi have been isolated however cultures may also be negative. Another factor is abnormal intestinal flora or the growth of infectious organisms in the gut such as E. coli and Klebsiella pneumoniae. Infants can be exposed to such infections by exposure to broad spectrum antibiotics, which alter normal bacterial flora in the gut. Other experts believe that NEC can also be brought about by problems in maternal blood flow such as maternal hypertension, preeclampsia and illegal drug exposure. It is also said that human milk may be protective against NEC.
This disease is more common in premature infants although it can also be seen in term infants. It is also observed to be more common in the second or the third week of life of premature infants who have been fed with milk formulas. Signs and symptoms observed in patients include the passage of bloody stools, abdominal enlargement, and a sign called pneumatosis intestinalis. Sepsis may also be a complication and can cause fever, weakness and other non-specific signs and symptoms. Initially, the infant may show intolerance to feeding and delayed gastric emptying which may later on lead to abdominal distension and tenderness. Upon auscultation, there may be decreased bowel sounds, leading one to think that ileus may have set in. There may also be redness of the abdominal wall and bloody stools. Later on, there may be pauses in breathing or apnea, weakness, shock, bleeding and coagulopathy and cardiovascular collapse. Laboratory findings would include low sodium levels, low platelet count, metabolic acidosis, low white blood cell counts or elevated white blood cell counts with shift to the left, decreased neutrophil count and prolonged prothrombin time and activated partial thromboplastin time. All these laboratory findings may be non-specific and cannot accurately predict prognosis for NEC.
Markers for NEC
Recently, researchers from Loyola University Health System have found a marker that helps identify infants who are at high risk for necrotizing enterocolitis. This can be a big help to doctors since they are now able to impose strategies to prevent the disease once they have identified this marker. The findings of this study were published at the Journal of Pediatric Surgery.
The study began to utilize 177 premature infants who were born at less than 32 weeks’ gestation and who were born weighing less than 3 pounds, 3 ounces. Blood samples from these infants were obtained after 72 hours of birth and were also obtained every week for one month. The samples were examined for reticulated platelets (RP) and intestinal alkaline phosphatase (iAP). About 8.5 percent of these infants developed NEC and out of those who developed NEC, 93 percent have had low RP levels while 60 percent have elevated levels of iAP. The researchers inferred that those with low RP levels are more likely to develop NEC than those with high iAP.
More studies are needed to properly identify the relationship between the risk of NEC and RP or iAP levels. For more information on other pediatric diseases, you can browse our other articles on this site.