Abstract
Neonatal necrotizing enterocolitis is the most common serious gastrointestinal disorder encountered in neonatal intensive care units. It is a major cause of morbidity and mortality in the newborn, particularly in premature infants. Consistent risk factors are birth weight and prematurity. Polycythemia and hyperviscosity altering blood flow and infectious agents are also implicated. Clinical findings include abdominal distention and diarrhea, and systemic symptoms such as apnea, acidosis, and lethargy. Pneumatosis intestinalis can be demonstrated radiographically. Mucosal ulcerations, hemorrhage, and thrombosis occur early, followed by inflammatory changes. Later still necrosis develops. Ischemia, infection, and enteral feedings are suspected to be involved in the pathophysiology. Eicosanoids, especially thromboxane, platelet-activating factor, and leukotrienes are likely mediators.
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Ryder RW, Shelton JD, Guinan ME: Necrotizing enterocolitis: A prospective multicenter investigation. Am J Epidemiol 112:113–123, 1980
Kanto WP, Wilson R, Breart GL, Zierlers S, Purohit OM, Peckham GJ, Ellison RC: Perinatal events and necrotizing enterocolitis in premature infants. Am J Dis Child 141:167–169, 1987
Stoll BJ, Kano WP, Glass RI, Nahmias AJ, Brannon AW: Epidemiology of necrotizing entercolitis: A case-control study. J Pediatr 96:447–451, 1980
Kleigman RM, Fanaroff AA: Neonatal necrotizing enterocolitis: A nine-year experience. Am J Dis Child 135:603–607, 1981
Polin RA, Pollack PF, Barlow B, Wigger JH, Slovis TL, Santulli TU, Heiro WC: Necrotizing enterocolitis in term infants. J Pediatr 89:460–462, 1976
Kleigman RM, Hack M, Jones P, Fanaroff AA: Epidemiological study of necrotizing enterocolitis among low-birth-weight infants. J Pediatr 100:440–444, 1982
Bauer CR, Morrison JC, Poole WR, Korones SB, Boehm JJ, Rigatto H, Zachman RD: A decreased incidence of necrotizing enterocolitis after prenatal glucocorticoid therapy. Pediatrics 73:682–687, 1984
Collaborative Group on Antenatal Steroid Therapy: Effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome. Am J Obstet Gynecol 141:276–287, 1984
Wilson R, delPortillo M, Schmidt E, Feldman RA, Kanto WP Jr: Risk factors for necrotizing enterocolitis in infants weighing more than 2000 grams at birth: A case-control study. Pediatrics 71:19–21, 1983
Moomjian A, Peckham G, Fox W, Pereira GR, Schaberg DA: Necrotizing enterocolitis endemic vs epidemic form. Pediatr Res 12:5530, 1978
Gregory JR, Campbell JR, Harrison MW, Campbell TJ: Neonatal necrotizing enterocolitis: A 10-year experience. Am J Surg 141:562–567, 1987
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T: Neonatal necrotizing enterocolitis: Therapeutic decisions based upon clinical staging. Ann Surg 187:1–6, 1978
Benirschke K: NEC in the newborn infant: Report of 68th Ross Conference on Pediatric Research. Columbus, Ohio; Ross Laboratories, 1974, p 27
Arnon RG, Fishbein JF: Portal venous gas in the pediatric age group. J Pediatr 79:255–259, 1971
Leonard T, Johnson A, Pettet PG: Critical evaluation of the persistent loop sign in necrotizing enterocolitis. Radiology 142:385–386, 1982
Santelli TV, Schullinger JN, Haird WC, Gongaware RD, Wigger J, Barlow B, Blanc W, Berdon WE: Acute necrotizing enterocolitis in infancy: A review of 64 cases. Pediatrics 55:376–387, 1975
Touloukian RJ, Posch JN, Spencer R: The pathogenesis of ischemic gastroenteritis of the neonate: Selective gut mucosal ischemia in asphyxiated neonatal piglets. J Pediatr Surg 7:194–207, 1972
Lloyd JR: The etiology of gastrointestinal perforation in the newborn. J Pediatr Surg 4:77–84, 1969
Brady P, Garik T, German J: Fetal heart rate patterns in infants in whom necrotizing enterocolitis develops. Arch Surg 115:1050, 1980
Yu VY, Tudehope DI: Neonatal necrotizing enterocolitis II. Perinatal risk factors. Med J Aust 1:688, 1977
Virnig NZ, Reynolds JW: Epidemiological aspects of neonatal necrotizing enterocolitis. Am J Dis Child 128:186–190, 1974
Tyson JE, deSa DJ, Moore S: Thromboartheromatous complications of umbilical arterial catheterization in the newborn period. Arch Dis Child 51:744–754, 1976
Bunton GL, Durbin GM, McIntosh N, Shaw, DG, Taghizadeh, A, Reynolds EOR, Rivers RPA, Urman G: Necrotizing enterocolitis: Controlled study of 3 years' experience in a neonatal intensive care unit. Arch Dis Child 52:772–777, 1977
Kliegman R, Stork E, Fanaroff A: Lack of relationship between umbilical arterial catheter complications and necrotizing enterocolitis. Pediatr Res 19:349A, 1985
Leake RD, Thanopoulos B, Nieberg R: Hyperviscosity syndrome associated with necrotizing enterocolitis. Am J Dis Child 129:1192–1194, 1975
Le Blanc MH, D'Cruz C, Pate K: Necrotizing enterocolitis can be caused by polycythemic hyperviscosity in the new-born dog. J Pediatr 105:804–808, 1984
Kliegman RM: Neonatal necrotizing enterocolitis: Implications for an infectious disease. Pediatr Clin North Am 26:327–344, 1979
Book LS, Overall JUC, Herbst JJ, Britt MR, Epstein B, Jung AL: Clustering of necrotizing enterocolitis: Interruption by infection-control measures. N Engl J Med 297: 984–986, 1977
Cushion AH: Necrotizing enterocolitis ofEscherichia coli: Heat-labile enterotoxin. Pediatrics 71:626–630, 1983
Hill HR, Hunt CE, Matsen JM: Nocosomial colonization with klebsiella type 26, in a neonatal intensive care unit associated with an outbread of sepsis, meningitis and necrotizing enterocolitis. J Pediatr 85:415–449, 1974
Powell J, Bureau M, Pare C, Galiory ML, Cabana D, Patriquin H: Necrotizing enterocolitis: epidemic following an outbreak of enterobacter cloaca. Am J Dis Child 134:1152–1154, 1980
Chany C, Mostovici O, Lebon P, Rousset S: Association of coronavirus with neonatal necrotizing enterocolitis. Pediatrics 69:209–218, 1982
Anderson C, Collin M, Okeefe J: A widespread epidemic of mild necrotizing enterocolitis of unknown cause. Am J Dis Child 138:979, 1984
Lawrence G, Bates J, Gal A: Pathogenesis of necrotizing enterocolitis. Lancet 1:137–139, 1982
Cashore WJ, Peter G, Lauermann M, Stonestreet BS, Oh W: Clostridial colonization and clostridial toxin in neonatal necrotizing enterocolitis. J Pediatr 98:308–311, 1981
Yale CE, Balish E: The importance of six common bacteria in intestinal strangulation. Arch Surg 107:438–442, 1972
Yale CE, Balish E, Wu JP: The bacterial etiology of pneumotosis cystoides intestinalis. Arch Surg 109:89, 1974
Barlow B, Santulli TV, Heird WA, Pitt J, Blanc WA, Schullinger JN: An experimental study of acute neonatal enterocolitis-the importance of breast milk. J Pediatr Surg 9:587–594, 1974
Kliegman RM, Pittard WE, Fanakroff AA: Necrotizing enterocolitis in neonates fed human milk. J Pediatr 95:450–453, 1979
Book LS, Herbst JJ, Atherton SO, Jung AL: Necrotizing enterocolitis in low-birth-weight infants fed an elemental formula. J Pediatr 87:602–605, 1975
Goldman HI: Feeding and necrotizing enterocolitis. AM J Dis Child 134:553–555, 1980
Osterrag SG, LaGamma EF, Reisen CE, Ferrentino FL: Early enteral feeding does not affect the incidence of necrotizing enterocolitis. Pediatrics 77:275–280, 1987
deLemos RA, Rogers JH, McLaughlin GW: Experimental production of necrotizing enterocolitis in newborn goats. Pediatr Res 8:380, 1974(abstract)
Willis DM, Chabot J, Raddle IC, Chance GW: Unsuspected hyperosmolarity of oral solutions contributing to necrotizing enterocolitis in very-low-birth-weight infants. Pediatrics 60:535–538, 1977
Brown EG, Sweet AY: Preventing necrotizing enterocolitis in neonates. JAMA 240:2452–2454, 1978
Murrell TJC, Roth L: Necrotizing jejunitis: A newly discovered disease in the highlands of New Guinea. Med J Aust 1:68, 1963
Nowicki PT, Stonestreet BS, Hansen NB, Yao AC, Oh W: Gastrointestinal blood flow and oxygen consumption in awake newborn piglets: Effects of feeding. Am J Physiol 245:G697-G702, 1983
Engel R: Necrotizing enterocolitis in the newborn: Report of 68th Ross Conference on Pediatric Research, Columbus, Ohio. Ross Laboratories, 1974, pp 66–71
Book LS, Herbst JJ, Jung AL: Comparison of fast- and slow-feeding rate schedules to the development of necrotizing enterocolitis. J Pediatr 89:463–466, 1976
LaGamma EF, Ostertag SG, Birenbaum H: Delayed feeding fails to prevent necrotizing enterocolitis. Am J Dis Child 139:385–389, 1985
Anysley-Green A: Hormones and postnatal adaptation to enterai nutrition. J Pediatr Gastroenterol Nutr 2:418, 1983
Hyman PE, Abrams CE, Zipser RD: Enhanced urinary immunoreactive thromboxane in neonatal necrotizing enterocolitis: A diagnostic indicator of thrombotic activity. Am J Dis Child 141:686–689, 1987
Gonzalez-Guzzi F, Hsueh W: Experimental model of ischemic bowel necrosis. The role of platelet activating factor and endotoxin. Am J Pathol 112:127–135, 1983
Hsueh W, Gonzalez-Crussi F, Arroyave JL: Platelet-activating factor-induced ischemic bowel necrosis. Am J Pathol 122:231–239, 1986
Hseuh W, Gonzales-Crussi F, Arroyave JL: Release of leukotriene C4 by isolated perfused rat small intestine in response to platelet-activating factor. J Clin Invest 78:108–114, 1986
Clark DA, Pelley RP, Schneider AJ: Interaction between bovine casein andV. cholera enterotoxin in the rabbit ileal loop. Pediatr Res 17:1008–1012, 1983
Clark DA, Thompson JE, Weiner LB, Micmillian JA, Schneider AJ, Rokahr JE: Necrotizing enterocolitis: Intraluminal biochemistry in human neonates and a rabbit model. Pediatr Res 19:919–921, 1985
Clark DA, Mullane K, Caravella S, McNeill H, Dweck HS, Miller MJS: Eicosanoid and leukocyte participation in experimental necrotizing enterocolitis. Pediatr Res 21:407, 1987 (abstract)
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Cheromcha, D.P., Hyman, P.E. Neonatal necrotizing enterocolitis. Digest Dis Sci 33 (Suppl 3), 78S–84S (1988). https://doi.org/10.1007/BF01538135
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DOI: https://doi.org/10.1007/BF01538135