Neonatal Necrotizing Enterocolitis
DOI:
https://doi.org/10.14238/pi18.9-10.1978.287-98Keywords:
necrotizing, enterocolitis, neonatalAbstract
Neonatal Necrotizing Enterocolitis (NEC) is a highly lethal disease of the newborn infant, which has aroused great interest in the past decades. It is characterized by ischemic necrosis of the intestinal wall, frequently leading to perforation and death. Unlike most neonatal emergencies, it is acquired and can be successfully treated without operation in most cases.The etiology is still obscure and is considered to be multifactorial. Intesti11al ischemia, infections, cow's milk, and hyperosmolar feeding are among the important factors associated with the pathogenesis of NEC in the newborn Many other factors are also related to the occurrence of this disease but some of them are still controversial.
The general opinion is that requiring a background of mucosal ischemia and damage; the presence of both intestinal bacteria and enteric feedings appear to be of significant etiologic factors. The important pathologic lesion is the mucosal damage and necrosis involving mostly the ileum and colon exdept the duodenum. Perforations usually occur in the ileocecal region where the intestinal wall is extremely thin.
References
AGERTY, H.A.; ZISERMAN, A.J. and SHOLLENBERGER, C.L. : A case of perforation of the ileum in a newborn infant with operation and recovery. J. Pediatr. 22 : 233 (1943). Cited by Santulli et al., 1975.
AZIZ, E.M. : Neonatal pneumatosis intestinalis associated with milk intolerance. Am. J. Dis. Child. 125 : 560 (1973).
BARLOW, B.; SANTULLI, T.V.; HEIRD, W.C.; PITT, J.; BlANC, W.A. and SCHULLINGER, J.N. : An experimental study of acute neonatal enterocolitis; the importance of breast milk. J. Pediatr. Surg. 9 : 587 (1974).
BEHRMAN, R.E. : Neonatology; diseases o:f the fetus and infant. p. 400 (Mosby, St. Louis 1973).
BELL, M.J.; KOSLOSKE, AM.; BENTON, C. and MARTIN, L.W. : Neonatal necrotizing enterocolitis; prevention of perforation. J. Pediatr. Surg. 8 : 601 (1973).
BELL, R.S.; GRAHAM, C.B. and STEVENSON, J.K. : Roentgnologic and clinical manifestations of neonatal necrotizing enterocolitis. Am. J. Roentgenol. Rad. Ther. Nucl. Med. 112 : 123 (1971).
BERDON, W.E.; GROSSMAN, H.; BAKER, D.H.; MIZRAHI, A.; BARLOW, O. and BLANC, W.A. Necrotizing enterocolitis in the premature infant. Radiology 83 : 879 (1964).
BOOK, L.S.; HERBST, J.J.; ATHERTON, S.O. and JUNG, A.L. : Necrotizing enterocolitis in low birth weight infants fed an elemental formula. J. Pediatr. 87 : 602 (1975).
BOOK, L.S.; HERBST, J.J. and JUNG, A.L. : Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J. Pediatr. 89 : 463 (1976a).
BOOK, L.S.; HERBST, J.J. and JUNG, A.L. : Carbohydrate malabsorption in necrotizing enterocolitis. Pediatr. 57 : 201 (1976b).
CORKERY, J.J; DUBOWIT, V.; LISTER, J. and MUOSA, A. : Colonic perforation after exchange transfusion. Br. med. J. 4 : 345 (1968).
DENES, J.; GERGELY, K.; WOHLMUTH, G. and LEB, J. Necrotizing enterocolitis of premature infants. Surgery 68 : 558 (1970).
DUDGEON, D.L.; CORAN, A.G.; LAUPPE, F.A.; HODGMAN, J.E. and ROSENKRANTZ, J.G. : Surgical management of acute necrotizing enterocolitis in infancy. J. Pediatr. Surg. 8 : 607 (1973).
EGAN, E.A.; MANTILLA, G.; NELSON, R.M. and EITZMAN, D.V. : A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis. J. Pediatr. 89 : 467 (1976).
ENGEL, R.R.; VIRNIG, N.L.; HUNT, C.E. and LEVITT, M.D. : Origin of mural gas in necrotizing enterocolitis; abstracted. Pediatr. Res. 7 : 292 (1973).
FRANTZ, I.D.; L'HEUREUX, P.; ENGEL, R.R. and HUNT, C.E. : Necrotizing enterocolitis. J. Pediatr. 86 : 259 (1975).
GENERISCH, A. : Bauchfellemwndung beim neugeborenen in folge von petioration des ileums. Arch. Pathol. Anat. 126 : 485 (1891). Cited by Santulli et al., 1975.
HAKANSON, D.O. and OH, W.: Necrotizing enterocolitis and hyperviscosity in the newborn infant. J. Pediatr. 90 458 (1977).
HERBEST, J.J. : Ross Conference on Pediatric Research; necrotizing enterocoli1is in the newborn infant. Columbus, Ohio, Ross Lab., p. 71 (1975). Cited by Touloukian, 1976.
HERMANN, R.E. : Penforation of the colon from necrotizing enterocolitis in the newborn; report of a survival and a new etiologic concept. Surgery 58 : 436 (1965).
HILL, H.R.; HUNT, C.E. and MATSEN, J.M. : Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis. J. Pediatr. 85 : 415 (1974) .
HOPKINS, G.B.; GOULD, V.E.; STEVENSON, J.K. and OLIVER, T.K. : Necrotizing enterocolitis in premature infants; a clinical and pathological evaluation of autopsy material. Am. J. Dis. Child. 120 : 229 (1970).
HUTTER, J.J.; HATHAWAY, E.E. and WAYNE, E.R. : Hematologic abnormalities in severe neonatal necrotizing enterocolitis. J. Pediatr. 88 : 1026 (1976).
JOSHI, V.V.; WINSTON, Y.E. and KAY, S. : Neonatal necrotizing enterocolitis. Am. I. Dis. Child. 126 : 113 (1973).
KITTERMAN, J.A. : Ross Contference on Pediatric Research; necrotizing enterocolitis in the newborn infant. Colombus, Ohio, Ross Lab., p. 38 (1975). Cited by Touloukian, 1976.
KRASNA, I.H.; FOX, H A.; SCHNEIDER, K.M. : Low molecular weight dextran in the treatment of enterocolitis and midgut volvulus in infants. J. pediatr. Surg. 8 : 615 (1973). Cited by Touloukian, 1976.
KROUSKOP, R.W.; BROWN, E.G. and SWEET, A.Y. : The relationship of feeding to necrotizing enterocolitis; abstracted. Pediatr. Res. 8 : 383 (1974).
LEAKE, R.D.; THANOPOULOS, B. and NIEBERG, R. : Hyperviscosity syndrome associated with necrotizing enterocolitis. Am. J. Dis. Child. 129 : 1192 (1975).
LEONIDAS, J.C. and HALL, R.T. : Neonatal pneumatosis coli; a mild form of necrotizing enterocolitis. J. Pediatr. 89 : 456 (1976).
LLOYD, J.R. : The etiology of gastrointestinal perforation in the newborn. J. pediatr. Surg. 4 : 77 (1969).
MIZRAHI, A.; BARLOW, O.; BERDON, W.; BLANC, W.A. and SILVERMAN, W.A. : Necrotizing enterocolitis in premature infants. J. Pediatr. 66 : 697 (1965).
NELSON, J.D. : Commentary. J. Pediatr. 89 : 471 (1976).
PITT, J.; BARlOW, B.; HEIRD, W.C. and SANTULLI, T.V. : Macrophages and the protective action of breast milk in necrotizing enterocolitis; abstracted. Pediatr. Res. 8 : 384 (1974).
POLIN, A.R.; POLLACK, P.F.; BARlOW, B.; WIGGER, H.J.; SIOVIS, T.L.; SANTULLI, T.V. and HEIRD, W.C. : Necrotizing enterocolitis in term infants. J. Pediatr. 89 : 460 (1976).
POWELL, G.K. : Enterocolitis in low birth weight infants associated with milk and soy protein intolerance. J. Pediatr. 88 : 840 (1976).
RICHMOND, J.A. and MIKITY, V. : Benign form of necrotizing enterocolitis. Am. J. Roentgenol. rad. Ther. nucl. Med. 123 : 301 (1975).
ROBACK, S.A.; POKER, J.; FRANTZ, I.F.; HUNT, C.E.; ENGEL, R.R. and LEONARD, A.S. : Necrotizing enterocolitis; an emerging entity in the regional infant intensive care facility. Arch. Surg. 109 : 314 (1974).
ROBINSON, A.E.; GROSSMAN, H. and BRUMLEY, G. : Pneumatosis entestinalis in the neonate. Am. J. Roentgenol. rad. Ther. nucl. Med. 120 : 333 (1974).
SANTULLI, T.V.; SCHULLINGER, J.N.; HEIRD, W.C.; GONGAWARE, R.D.; WIGGER, J.; BARLOW, B.; BLANC, W.A. and BERDON, W.E. : Acute necrotizing enterocolitis in infancy; a review of 64 cases. Pediatrics 55 : 376 (1975).
SPEER, M.E.; TABER, L.H.; YOW, M.D.; RUDOLPH, A.J.; URTEAGA, R.N. and WALLER, M.T. : Fulminant neonatal sepsis and necrotizing enterocolitis associated with a "non enteroropathogenic" strain of Escherichia coli. J. Pediatr. 89 : 91 (1976).
STEIN, H.; BECK, J.; SOLOMON, A. and SCHMAMAN, A. : Gastroenteritis with necrotizing enterocolitis in premature babies. Br. med. J. 2 : 616 (1972).
STEVENSON, J.K.; OLIVER, T.K.; GRAHAM, C.B.; BELL, R.S. and GOULD, V.E. : Aggressive treatment of neonatal necrotizing enterocolitis; 38 patients with 25 survivors. J. pediatr. Surg. 6 : 28 (1971).
TAN, K.L.; TAN, A.Y.O.; WONG, T.T.T. : Necrotizing enterocolitis in young infants; five examples. Clin. Pediatr. 11 : 44 (1972).
THELANDER, H.E. : Penforation of the gastrointestinal tract of the newborn infant. Am. J. Dis. Child. 58: 371 (1939). Cited by Santulli et al., 1975.
TOULOUKIAN, R.J. : Neonatal necrotizing enterocolitis; an update on eticlogy, diagnosis, and treatment. Surg. Clin. North. Am. 56 : 281 (1976).
TOULOUKIAN, R.J.; BERDON, W.E.; AMOURY, R.A. and SANTULLI, T.V.: Surgical experience with necrotizing enterocolitis in the infant. J. pediatr. Surg. 2 : 389 (1967).
VOLLMAN, J.H.; SMITH, W.L and TSANG, R.C. : Necrotizing enterocolitis with recurrent hepatic portal venous gas. J. Pediatr. 88 : 486 (1976).
WAYNE, E.R.; BURRINGTON, J.D. and HUTTER, J. : Neonatal necrotizing enterocolitis; evaluation of new principles in management. Arch. Surg. 110 : 476 (1975).
WOLFE, J.N. and EVANS, E.Z. : Gas in the portal veins of the liver in infants; a roentgenographic demonstration with post-mortem anatomical correlation. Am. J. Roentgenol. rad. Ther. .nucl. Med. 74: 486 (1955). Cited by Santulli et al., 1975.
AZIZ, E.M. : Neonatal pneumatosis intestinalis associated with milk intolerance. Am. J. Dis. Child. 125 : 560 (1973).
BARLOW, B.; SANTULLI, T.V.; HEIRD, W.C.; PITT, J.; BlANC, W.A. and SCHULLINGER, J.N. : An experimental study of acute neonatal enterocolitis; the importance of breast milk. J. Pediatr. Surg. 9 : 587 (1974).
BEHRMAN, R.E. : Neonatology; diseases o:f the fetus and infant. p. 400 (Mosby, St. Louis 1973).
BELL, M.J.; KOSLOSKE, AM.; BENTON, C. and MARTIN, L.W. : Neonatal necrotizing enterocolitis; prevention of perforation. J. Pediatr. Surg. 8 : 601 (1973).
BELL, R.S.; GRAHAM, C.B. and STEVENSON, J.K. : Roentgnologic and clinical manifestations of neonatal necrotizing enterocolitis. Am. J. Roentgenol. Rad. Ther. Nucl. Med. 112 : 123 (1971).
BERDON, W.E.; GROSSMAN, H.; BAKER, D.H.; MIZRAHI, A.; BARLOW, O. and BLANC, W.A. Necrotizing enterocolitis in the premature infant. Radiology 83 : 879 (1964).
BOOK, L.S.; HERBST, J.J.; ATHERTON, S.O. and JUNG, A.L. : Necrotizing enterocolitis in low birth weight infants fed an elemental formula. J. Pediatr. 87 : 602 (1975).
BOOK, L.S.; HERBST, J.J. and JUNG, A.L. : Comparison of fast and slow feeding rate schedules to the development of necrotizing enterocolitis. J. Pediatr. 89 : 463 (1976a).
BOOK, L.S.; HERBST, J.J. and JUNG, A.L. : Carbohydrate malabsorption in necrotizing enterocolitis. Pediatr. 57 : 201 (1976b).
CORKERY, J.J; DUBOWIT, V.; LISTER, J. and MUOSA, A. : Colonic perforation after exchange transfusion. Br. med. J. 4 : 345 (1968).
DENES, J.; GERGELY, K.; WOHLMUTH, G. and LEB, J. Necrotizing enterocolitis of premature infants. Surgery 68 : 558 (1970).
DUDGEON, D.L.; CORAN, A.G.; LAUPPE, F.A.; HODGMAN, J.E. and ROSENKRANTZ, J.G. : Surgical management of acute necrotizing enterocolitis in infancy. J. Pediatr. Surg. 8 : 607 (1973).
EGAN, E.A.; MANTILLA, G.; NELSON, R.M. and EITZMAN, D.V. : A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis. J. Pediatr. 89 : 467 (1976).
ENGEL, R.R.; VIRNIG, N.L.; HUNT, C.E. and LEVITT, M.D. : Origin of mural gas in necrotizing enterocolitis; abstracted. Pediatr. Res. 7 : 292 (1973).
FRANTZ, I.D.; L'HEUREUX, P.; ENGEL, R.R. and HUNT, C.E. : Necrotizing enterocolitis. J. Pediatr. 86 : 259 (1975).
GENERISCH, A. : Bauchfellemwndung beim neugeborenen in folge von petioration des ileums. Arch. Pathol. Anat. 126 : 485 (1891). Cited by Santulli et al., 1975.
HAKANSON, D.O. and OH, W.: Necrotizing enterocolitis and hyperviscosity in the newborn infant. J. Pediatr. 90 458 (1977).
HERBEST, J.J. : Ross Conference on Pediatric Research; necrotizing enterocoli1is in the newborn infant. Columbus, Ohio, Ross Lab., p. 71 (1975). Cited by Touloukian, 1976.
HERMANN, R.E. : Penforation of the colon from necrotizing enterocolitis in the newborn; report of a survival and a new etiologic concept. Surgery 58 : 436 (1965).
HILL, H.R.; HUNT, C.E. and MATSEN, J.M. : Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis. J. Pediatr. 85 : 415 (1974) .
HOPKINS, G.B.; GOULD, V.E.; STEVENSON, J.K. and OLIVER, T.K. : Necrotizing enterocolitis in premature infants; a clinical and pathological evaluation of autopsy material. Am. J. Dis. Child. 120 : 229 (1970).
HUTTER, J.J.; HATHAWAY, E.E. and WAYNE, E.R. : Hematologic abnormalities in severe neonatal necrotizing enterocolitis. J. Pediatr. 88 : 1026 (1976).
JOSHI, V.V.; WINSTON, Y.E. and KAY, S. : Neonatal necrotizing enterocolitis. Am. I. Dis. Child. 126 : 113 (1973).
KITTERMAN, J.A. : Ross Contference on Pediatric Research; necrotizing enterocolitis in the newborn infant. Colombus, Ohio, Ross Lab., p. 38 (1975). Cited by Touloukian, 1976.
KRASNA, I.H.; FOX, H A.; SCHNEIDER, K.M. : Low molecular weight dextran in the treatment of enterocolitis and midgut volvulus in infants. J. pediatr. Surg. 8 : 615 (1973). Cited by Touloukian, 1976.
KROUSKOP, R.W.; BROWN, E.G. and SWEET, A.Y. : The relationship of feeding to necrotizing enterocolitis; abstracted. Pediatr. Res. 8 : 383 (1974).
LEAKE, R.D.; THANOPOULOS, B. and NIEBERG, R. : Hyperviscosity syndrome associated with necrotizing enterocolitis. Am. J. Dis. Child. 129 : 1192 (1975).
LEONIDAS, J.C. and HALL, R.T. : Neonatal pneumatosis coli; a mild form of necrotizing enterocolitis. J. Pediatr. 89 : 456 (1976).
LLOYD, J.R. : The etiology of gastrointestinal perforation in the newborn. J. pediatr. Surg. 4 : 77 (1969).
MIZRAHI, A.; BARLOW, O.; BERDON, W.; BLANC, W.A. and SILVERMAN, W.A. : Necrotizing enterocolitis in premature infants. J. Pediatr. 66 : 697 (1965).
NELSON, J.D. : Commentary. J. Pediatr. 89 : 471 (1976).
PITT, J.; BARlOW, B.; HEIRD, W.C. and SANTULLI, T.V. : Macrophages and the protective action of breast milk in necrotizing enterocolitis; abstracted. Pediatr. Res. 8 : 384 (1974).
POLIN, A.R.; POLLACK, P.F.; BARlOW, B.; WIGGER, H.J.; SIOVIS, T.L.; SANTULLI, T.V. and HEIRD, W.C. : Necrotizing enterocolitis in term infants. J. Pediatr. 89 : 460 (1976).
POWELL, G.K. : Enterocolitis in low birth weight infants associated with milk and soy protein intolerance. J. Pediatr. 88 : 840 (1976).
RICHMOND, J.A. and MIKITY, V. : Benign form of necrotizing enterocolitis. Am. J. Roentgenol. rad. Ther. nucl. Med. 123 : 301 (1975).
ROBACK, S.A.; POKER, J.; FRANTZ, I.F.; HUNT, C.E.; ENGEL, R.R. and LEONARD, A.S. : Necrotizing enterocolitis; an emerging entity in the regional infant intensive care facility. Arch. Surg. 109 : 314 (1974).
ROBINSON, A.E.; GROSSMAN, H. and BRUMLEY, G. : Pneumatosis entestinalis in the neonate. Am. J. Roentgenol. rad. Ther. nucl. Med. 120 : 333 (1974).
SANTULLI, T.V.; SCHULLINGER, J.N.; HEIRD, W.C.; GONGAWARE, R.D.; WIGGER, J.; BARLOW, B.; BLANC, W.A. and BERDON, W.E. : Acute necrotizing enterocolitis in infancy; a review of 64 cases. Pediatrics 55 : 376 (1975).
SPEER, M.E.; TABER, L.H.; YOW, M.D.; RUDOLPH, A.J.; URTEAGA, R.N. and WALLER, M.T. : Fulminant neonatal sepsis and necrotizing enterocolitis associated with a "non enteroropathogenic" strain of Escherichia coli. J. Pediatr. 89 : 91 (1976).
STEIN, H.; BECK, J.; SOLOMON, A. and SCHMAMAN, A. : Gastroenteritis with necrotizing enterocolitis in premature babies. Br. med. J. 2 : 616 (1972).
STEVENSON, J.K.; OLIVER, T.K.; GRAHAM, C.B.; BELL, R.S. and GOULD, V.E. : Aggressive treatment of neonatal necrotizing enterocolitis; 38 patients with 25 survivors. J. pediatr. Surg. 6 : 28 (1971).
TAN, K.L.; TAN, A.Y.O.; WONG, T.T.T. : Necrotizing enterocolitis in young infants; five examples. Clin. Pediatr. 11 : 44 (1972).
THELANDER, H.E. : Penforation of the gastrointestinal tract of the newborn infant. Am. J. Dis. Child. 58: 371 (1939). Cited by Santulli et al., 1975.
TOULOUKIAN, R.J. : Neonatal necrotizing enterocolitis; an update on eticlogy, diagnosis, and treatment. Surg. Clin. North. Am. 56 : 281 (1976).
TOULOUKIAN, R.J.; BERDON, W.E.; AMOURY, R.A. and SANTULLI, T.V.: Surgical experience with necrotizing enterocolitis in the infant. J. pediatr. Surg. 2 : 389 (1967).
VOLLMAN, J.H.; SMITH, W.L and TSANG, R.C. : Necrotizing enterocolitis with recurrent hepatic portal venous gas. J. Pediatr. 88 : 486 (1976).
WAYNE, E.R.; BURRINGTON, J.D. and HUTTER, J. : Neonatal necrotizing enterocolitis; evaluation of new principles in management. Arch. Surg. 110 : 476 (1975).
WOLFE, J.N. and EVANS, E.Z. : Gas in the portal veins of the liver in infants; a roentgenographic demonstration with post-mortem anatomical correlation. Am. J. Roentgenol. rad. Ther. .nucl. Med. 74: 486 (1955). Cited by Santulli et al., 1975.
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Tjandra H. Neonatal Necrotizing Enterocolitis. PI [Internet]. 2017Jun.13 [cited 2025Apr.30];18(9-10):287-98. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1502
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Received 2017-06-09
Accepted 2017-06-09
Published 2017-06-13
Accepted 2017-06-09
Published 2017-06-13
