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Leitlinie zur nekrotisierenden Enterokolitis (NEK)

Guidelines on necrotizing enterocolitis (NEC)

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Zusammenfassung

Die nekrotisierende Enterokolitis (NEK) ist eine multifaktorielle entzündliche Erkrankung des Gastrointestinaltrakts unbekannter Genese. Bei Kindern unter 1500 g liegt ihre Inzidenz in Deutschland bei etwa 4–6%. Das Risiko ist umgekehrt proportional zu Geburtsgewicht und Gestationsalter. Die Letalität beträgt 15–30%, etwa 25% aller wegen einer NEK operierten Neugeborenen müssen längerfristig parenteral ernährt werden, und 8% entwickeln ein Kurzdarmsyndrom. Von der NEK zu unterscheiden ist die singuläre intestinale Perforation (SIP), bei der keine Nekrose der Mukosa vorliegt, die Kinder noch unreifer sind und früher erkranken. Ab einem NEK-Stadium Bell Grad II sollte unbedingt ein Facharzt für Kinderchirurgie eingebunden werden. Eine ausschließliche Peritonealdrainage statt einer Laparotomie unterscheidet sich im Outcome nicht und stellt daher bei extremer Unreife eine alternative Behandlungsmöglichkeit dar. Das Risiko einer NEK lässt sich durch die pränatale mütterliche Betamethasonprophylaxe zur fetalen Lungenreifung und durch die Gabe von Muttermilch senken. In Risikokollektiven können in Abhängigkeit von der lokalen NEK-Inzidenz Probiotika(-kombinations-)präparate eingesetzt werden.

Abstract

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal tract with an incidence in infants with a body weight <1,500 g of approximately 4–6%. The frequency is inversely proportional to birth weight and gestational age. Spontaneous intestinal perforation also occurs in very immature infants but is distinct from NEC with an earlier onset of symptoms and with no mucosal necrosis. The lethality of NEC is 15–30% and approximately 25% of operated infants need prolonged parenteral nutrition and 8% develop short bowel syndrome. lA pediatric surgeon should be involved in the decision making process at the latest by Bell stage II. Placement of peritoneal drainage alone is a viable alternative for very immature infants and has the same outcome as laparatomy. Prenatal maternal betamethason prophylaxis for fetal lung maturation and breast feeding reduces the risk of NEC. In hospital units with a high local NEC incidence prophylactic nutrition with a combination of probiotics can reduce the risk of NEC.

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  1. Neonatologie, Dr. von Haunersches Kinderspital, Perinatalzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum, Universität München, Maistraße 11, 80337, München, Deutschland

    O. Genzel-Boroviczeny

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Gesellschaft für Neonatologie und pädiatrische Intensivmedizin e.V. (GNPI), unter Beteiligung der Deutschen Gesellschaft für Kinderchirurgie (DGKiC)

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Correspondence to O. Genzel-Boroviczeny.

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In dieser Leitlinie wird das Evidenzbewertungssystem des Oxford Centre for Evidence-based Medicine Levels of Evidence (Mai 2001) benutzt (http://www.cebm.net/index.aspx?o=1025, abgefragt am 18.02.09). Die Kombinationen vom Buchstaben „E“ und Zahlen stufen den Evidenzgrad der dargestellten Empfehlungen (1 hoch, 5 niedrig). Die Empfehlungsgrade sind A (starke Empfehlung), B (Empfehlung), O (Empfehlung offen).

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Genzel-Boroviczeny, O., Gesellschaft für Neonatologie und pädiatrische Intensivmedizin e.V. (GNPI), unter Beteiligung der Deutschen Gesellschaft für Kinderchirurgie (DGKiC). Leitlinie zur nekrotisierenden Enterokolitis (NEK). Monatsschr Kinderheilkd 159, 968–976 (2011). https://doi.org/10.1007/s00112-011-2412-8

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