Login Register Cart 0
Generic placeholder image

Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Management of NEC: Surgical Treatment and Role of Traditional X-ray Versus Ultrasound Imaging, Experience of a Single Centre

Author(s): Giuseppe De Bernardo*, Desiree Sordino, Carolina De Chiara, Marina Riccitelli, Francesco Esposito, Maurizio Giordano and Antonino Tramontano

Volume 15, Issue 2, 2019

Page: [125 - 130] Pages: 6

DOI: 10.2174/1573396314666181102122626

Abstract

Introduction: Necrotizing enterocolitis is the most common cause of the postnatal critical conditions and remains one of the dominant causes of newborns’ death in Neonatal Intensive Care. The morbidity and mortality associated with necrotizing enterocolitis remains largely unchanged and the incidence of necrotizing enterocolitis continues to increase. There is no general agreement regarding the surgical treatment of the necrotizing enterocolitis.

Methods: In this paper, we want to evaluate the results obtained in our centre from different types of necrotizing enterocolitis’s surgical treatment and to analyse the role of traditional X-ray versus ultrasound doppler imaging in the evolutionary phases of necrotizing enterocolitis. The study was conducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon in Naples from January 2010 to December 2016. Patients were monitored by hematochemical examinations and radiological orthostatic exams every 12 hours, so that they had a surgical opportunity before intestinal perforation occurred. Ultrasonography was performed to monitor preterm infants who were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging.

Results: They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g (N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46 patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment. In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a 'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing enterocolitis, when the radiographic examination shows only a specific dilation of the loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness of wall sections.

Conclusions: Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegration of liquids but above all with timely diagnosis, aimed to discover early prodromic phases of wall damage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only when barrier damage is detected while US provides real-time imaging of abdominal structures, highlighting some elements that are completely excluded by radiograph.

Keywords: NEC, surgical treatment, clip and drop, second-look, anastomosis, abdomen ultrasound.

« Previous Next »
[1]
Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994; 21: 205-18.
[2]
Albanese CT, Rowe MI, O’Neill JA, et al. Necrotizing enterocolitis. Pediatric Surgery 1998; pp. 1297-320.
[3]
Henry MC, Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004; 28: 221-33.
[4]
Pang KK, Chao NS, Wong BP, Leung MW, Liu KK. The clip and drop back technique in the management of multifocal necrotizing enterocolitis: A single center experience. Eur J Pediatr Surg 2012; 22(1): 85-90.
[5]
Thyoka M, Eaton S, Kiely EM, et al. Outcomes of diverting jejunostomy for severe necrotizing enterocolitis. J Pediatr Surg 2011; 46(6): 1041-4.
[6]
Weber TR, Lewis JE. The role of second-look laparotomy in necrotizing enterocolitis. J Pediatr Surg 1986; 21: 323-5.
[7]
Cass DL, Brandt ML, Patel DL, et al. Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000; 35: 1531-6.
[8]
Morgan LJ, Shochat SJ, Hartman GE, et al. Peritoneal drainage as primary management of perforated NEC in the very low birth weight infant. J Pediatr Surg 1994; 29: 310-4.
[9]
Zornoza M, Peláez D, Romero R, et al. Role of peritoneal drainage in necrotizing enterocolitis in critical infants with extremely low birth weight. Chir Pediatr 2011; 24(3): 146-50.
[10]
Rao SC, Basani L, Simmer K, et al. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev 2011; 15(6)CD006182
[11]
Vaughan WG, Grosfeld JL, West K, et al. Avoidance of stomas and delayed anastomosis for bowel necrosis: The ‘clip and drop-back’ technique. J Pediatr Surg 1996; 31(4): 542-5.
[12]
Bell MJ, Ternberg JI, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1-7.
[13]
Walsh MC, Kliegman RM. Necrotizing enterocolitis: Treatment based on staging criteria. Pediatr Clin N Am 1986; 33: 179-201.
[14]
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364: 255-64.
[15]
Bohnhorst B. Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal 2013; 98: 445-50.
[16]
McCarten KM. Ultrasound of the gastrointestinal tract in the neonate and young infant with particular attention to problems in the neonatal intensive care unit. Ultrasound Clin 2010; 5: 75-95.
[17]
Silva CT, Daneman A, Navarro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 2007; 37: 274-82.
[18]
Luig M, Lui K. NICUS Group et al. Epidemiology of necrotizing: enterocolitis: II. Risks and susceptibility of premature infants during the surfactant era: A regional study. J Paediatr Child Health 2005; 41: 174-9.
[19]
Holman RC, Stoll BJ, Clarke MJ, et al. The epidemiology of necrotizing enterocolitis infant mortality in the United States. Am J Public Health 1997; 87: 2026-31.
[20]
Kasivajjula H, Maheshwari A. Pathophysiology and current management of necrotizing enterocolitis. Indian J Pediatr 2014; 81(5): 489-97.
[21]
Hashem RH, Mansi YA, Almasah NS, Abdelghaffar S. Doppler ultrasound assessment of the splanchnic circulation in preterms with neonatal sepsis at risk for necrotizing enterocolitis. J Ultrasound 2017; 20: 59-67.
[22]
Epelman M, Daneman A, Navarro OM, et al. Necrotizing enterocolitis: Review of state-of-the-art imaging findings with pathologic correlation. Radiographics 2007; 27: 285-305.
[23]
Gire C. Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. J Pediatr Surg 2014; 49: 508-13.
[24]
Farnoodi MR. Complementory value of sonography in early evaluation of necrotizing enterocolitis. Polish J Radiol 2015; 80: 317-23.
[25]
Ramasamy V, Teo H, Rajadurai VS, Chandran S. Atypical presentation of acute fulminant neonatal necrotising enterocolitis: Diagnostic superiority of sonographic evaluation over plain radiography of abdomen. BMJ Case Rep bcr 2016; 21.
[26]
Muchantef K, Epelman M, Darge K, et al. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: Correlating findings with outcomes. Pediatr Radiol 2013; 43: 1444-52.
[27]
Palleri E, Kaiser S, Wester T, et al. Complex Fluid Collection on Abdominal Ultrasound Indicates Need for Surgery in Neonates with Necrotizing Enterocolitis. Eur J Pediatr Surg 2017; 27(2): 161-5.
[28]
Cuna A, Sampath V. Genetic alterations in necrotizing enterocolitis. Semin Perinatol 2017; 41(1): 61-9.

Rights & Permissions Print Cite
Article Metrics
33
8
© 2024 Bentham Science Publishers | Privacy Policy