Clinical Manifestation

The classic triad of symptoms includes abdominal distention, bilious vomiting, and bloody stools. Most patients, however, present with less specific symptoms. The onset of acute NEC has a bimodal pattern. It generally occurs in the first week of life (in newborns more than 34 weeks of gestational age), but in some it may be delayed to the second to the fourth week (mostly in those less than 30 weeks of gestational age). The affected term neonate is usually systemically ill with other predisposing maternal and individual conditions (see above). Premature babies are at risk for several weeks after birth, with the age of onset inversely related to their gestational age. The typical infant with NEC is premature and recovering from some form of stress, but is well enough to begin gavage feedings. Initial symptoms may include progressive subtle signs of feeding intolerance, and subtle systemic signs. In advanced disease, a fulminant systemic collapse and consumption coagulopathy occurs. Feeding intolerance can be manifested by abdominal distention/tenderness, delayed gastric emptying and vomiting. General symptoms can progress insidiously and include increased apnea and bradycardia, lethargy, and temperature instability. Fulminant NEC presents with acidosis, disseminated intravascular coagulation, peritonitis, profound apnea, rapid cardiovascular and hemodynamic collapse, and shock. Stools-reducing substance are elevated, the stools will show traces of occult blood, and diarrhea may be present. As abdominal distention progresses, the gastric residuals rise, and within a short period the urine volume decreases and osmolarity rises. Abdominal erythema can appear and gastric aspirate becomes bile stained. At this stage, the child may have hypotension and may have gross blood in diarrheal stools.

Infants with sudden onset have those symptoms more abruptly. NEC was staged by Bell et al. (44), but should also be further defined as either endemic or epidemic. Stage I (suspected NEC) of NEC is defined as the presence of abdominal distention poor feeding, and vomiting, and radiologically, there is ileus. Stage II (definite NEC) has also gastrointestinal bleeding, and radiologically is defined by pneumatosis intestinals and portal vein gas. Stage III is advanced NEC, has also septic shock, and radiologically there is pneumopentoneum. All stages are treated medically, and Stage III also surgically.

Differential diagnosis includes sepsis in the early stages, and at later stages, metabolic disorders, congenital heart diseases, intraventriculus hemorrhage, and infections. Other diagnoses included omphalitis, intestinal malabsorption or volvulus, infection enterocolitis, neonatal appendicitis, spontaneous perforation, urinary infection, and Hirschsprung disease.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook

Post a comment