Question

Case Study A female neonate was born 8 weeks premature 32 weeks' gestation. She is currently 3 weeks of age and has recently advanced to oral feedings with arteficial infant formula as her sole source of nutrition. She developed symptoms that suggest that she is developing necrotizing enterocolitis (NEC). From your reading on NEC, answer the following questions: 1. What anatomic problem would most likely lead to the symptoms associated with NEC? 2. What causes the underlying pathology associated with NEC? 3. What are the risk factors for this neonate that would suggest NEC? 4. What are the clinical manifestations you would expect with NEC? 5. What diagnostic tests might be used to identify NEC? 6. How would you manage an infant with NEC?

Answer 1

1.ans - NEC usually occurs due to injury of the mucosal wall caused by ischemic damage of the intestinal mucosal barrier as a result of different stressful condition like fetal distress, perinatal asphyxia, hypothermia, respiratory distress syndrome. Other problems like bacterial infection by E. coli, pseudomonas and stasis of intestinal contents due to poor peristalsis would most likely lead to NEC.

2ans.- The underlying pathology is believed to have different causes including intestinal immurity and microbial infection.Intestinal immaturity causes more vulnerable intestinal mucosa, weak immune system and alteration in vascular development.So when intestinal mucosa exposed to luminal bacterial flora with the compromised immune system due to arteficial feeding or any other factors the mucosa becomes infected and sepsis occurs.

3ans- The risk factors for this neonate are

• prematurity - as the neonate born 8weeks ago the gut maturity got compromised as a result the lowef peristalsis caused less movement of intestinal contents resulting stasis.
• Feeding - Formula feeding is another risk factor as it provokes the condition. Improper sterilization, unhygienic feeding practices and also formula feeding itself causes more bacterias to go inside the immature gut of baby. Thus the immature gut exposed to luminal bacterias and got infected and ends up with NEC.

4.ans - Clinical features described in three stages -

• stage l - neonates usually present with lethargy. abdominal distension,vomiting, blood in stool, instability in body temperature, bradycardia, apnoea and cyanosis.
• stage ll-in this stage neonates present with features of stage 1 along with decreased bowel sound, metabolic acidosis and mild thrombocytopenia.
• stage lll - in this stage neonates present with all features of stage 1 and stage 2 along with low blood pressure,disseminated intravascular coagulation,anuria and peritonitis.

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5.ans-diagnostic tests to be done are -

• X-ray abdomen
• blood count
• sepsis screening
• culture and sensitivity (blood, urine, stool, CSF)

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6Ans-management - warmth, fluid therapy for maintenance of fluid and electrolyte balance, management of shock with fluid resuscitation and vasopressors,no oral feeding, insertion of gastric tubes to relieve abdominal distension and to aspirate gastric contents and continue monitoring to be provided. parenteral nutrition, plasma and platelet transfusion, antibiotic therapy may be needed

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