Case reports: necrotizing enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency and cause of significant morbidity and mortality in preterm infants. The typical presentation is that of a preterm infant beyond first week of age on substantial enteral feeding who suddenly presents with gastrointestinal symptoms. The diagnosis of NEC is confirmed by abdominal x-ray findings. The precise mechanism for initiation of the inflammatory cascade in NEC is still unknown; two major risk factors are prematurity and advancing enteral feeds. Less commonly it can occur in term or preterm infants, without being fed, who have suffered a hypoxic ischemic injury to the intestine. In either case, there is intestinal wall inflammation with necrosis and sub-mucosal gas formation. The severity of inflammation and extent of bowel involvement is variable resulting in a spectrum from medically managed NEC to surgical NEC or profoundly unstable, metabolic acidosis and death. Early recognition, bowel rest, antimicrobial therapy, periodic radiological evaluation, supportive therapy of fluids, electrolytes and nutrition are the mainstays of management. We present 3 cases of NEC in preterm infants with varying degree of severity and different outcomes.