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Necrotizing enterocolitis is a severe inflammatory disease of the intestine and is the main cause of death in infants, mostly occurring in premature infants. Intestinal obstruction may occur during the medical treatment of necrotizing enterocolitis. A common cause of intestinal obstruction is intestinal stricture, and entero-enteric fistulas may form in the proximal portion of the intestinal stricture. Several mechanisms may be suggested for the development of entero-enteric fistula. Intestinal ischemia and subsequent necrosis do not become intestinal perforation over time, causing an inflammatory reaction, and are attached to the adjacent intestine, forming a fistula. Alternatively, a subacute perforation may be sealed off by the adjacent intestine, resulting in fistula formation. Entero-enteric fistulas are closely related to distal stricture and occurs when there is a localized perforation rather than a generalized perforation. Fistulas can be diagnosed via contrast enema examination or distal loopogram, and surgical resection is required. Here, I report a case of a preterm infant with an entero-colonic fistula secondary to necrotizing enterocolitis. The patient had abdominal distention and bloody stool and was confirmed to have rotavius enteritis. Plain abdominal radiographs showed pneumatosis intestinalis. The patient received medical treatment for necrotizing enterocolitis. While the symptoms were improving, he vomited again, and intestinal obstruction was suspected. Gastrografin enema was performed due to intestinal obstruction, and an enterocolonic fistula was found.

Purpose To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

Neonatal gastrointestinal mucormycosis, a rare disease with a high mortality rate, shows a rapid progressive course in premature infants with an immature immune system. We report the case of a male neonate weighing 970 g, delivered via cesarean section at 27 weeks, as one of a pair of dizygotic twins. From the 7th day after birth, bile was seen to drain through the orogastric tube, and paralytic ileus was noted on performing an abdominal X-ray. Thus, oral feeding was discontinued because necrotizing enterocolitis (NEC) was highly suspected. On the 9th day after birth, a firm mass was palpable in left upper abdominal quadrant, but no pneumatosis intestinalis was observed on performing abdominal X-ray. Small bowel intussusception was suspected on performing abdominal ultrasonography. Based on these findings, an exploratory laparotomy was performed, and although no intussusception was found intraoperatively, we performed a partial gastrectomy and hemicolectomy due to the presence of necrotic changes and perforations of the stomach and colon. Postoperatively, he was observed to have hypotension with persistence of hemorrhage at the surgical site. He died on the 11th day after birth. Intraoperative histopathological examination of stomach and colon showed fungal aseptate hyphae with broad branching. Gastrointestinal mucormycosis was confirmed based on findings of vascular involvement in the form of fungal hyphae and thrombosis in the transmural blood vessels. We report a case of an extremely low birth weight infant with neonatal gastrointestinal mucormycosis with an initial clinical presentation suggestive of intussusception and atypical NEC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of exclusive breast milk feeding (BMF) on the incidence of necrotizing enterocolitis (NEC) in preterm infants. Methods: All newborn infants, born at <32 weeks of gestation and weighing <1,500 g, admitted to the neonatal intensive care center at Seoul National University Bundang Hospital during the study period, were included. The study was divided into period I: pre-exclusive BMF (January 2010-March 2014) and period II: exclusive BMF (April 2014-December 2016). Results: A total of 374 infants were enrolled in this study, with 174 in period I and 174 in period II. The incidence of NEC was 11.5% in period I and 3.4% in period II. As the mean gestational age and birth weight were significantly greater in infants in period II, the difference in the incidence of NEC between the two periods was adjusted by gestational age. After adjustment, the incidence of NEC in period II was significantly lower than in period I (P=0.024). Conclusion: Exclusive BMF significantly reduced the incidence of NEC in a single neonatal intensive care center. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the influence of routine probiotic supplementation on causes of neonatal morbidity and mortality, such as necrotizing enterocolitis (NEC) and late onset sepsis. Methods: All neonates born at <32 weeks of gestation and weighing <1,500 g admitted to the neonatal intensive care unit during the study period were included. The study period was divided into the pre-probiotic period, between January 2009 and February 2011, and the probiotic period, between November 2012 and December 2014. The probiotic given was a mixture of Lactobacillus plantarum, L. rhamnosus, Bifidobacterium lactis and B. longum, administered at the time of the first feeding over 2 mL once daily. Results: A total of 358 infants were screened for enrollment, with 149 infants included in the pre-probiotic group (mean birth weight 937 g, mean gestational age 27.9 wk), and 158 in the probiotic group (1,040 g, 28.6 wk). Probiotics had no statistically significant impact on NEC and late onset sepsis. However, three cases of probiotic related sepsis occurred after the infants were routinely administered probiotics in our unit. Conclusion: Routine probiotic supplementation did not reduce the incidence of NEC in very low birth weight (VLBW) infants. However, severe sepsis was caused by strains in the probiotic administered to patients. Therefore, routine prophylactic use of probiotic in VLBW infants should be performed cautiously. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the prognosis of necrotizing enterocolitis (NEC) according to the extent of involvement, among very low birth weight infants. Furthermore, the predictive factors for extent of involvement were evaluated. Methods: Medical records of all newborns with surgically treated NEC admitted to the neonatal intensive care unit of Seoul National University Children's Hospital between 2005 and 2013 were reviewed. Infants were grouped according to the extent of involvement of NEC: isolated segment involvement (ISI, n=31) and multi-segment involvement (MSI, n=17). We evaluated the clinical characteristics, outcomes, and pre-operative factors according to symptoms, laboratory and radiologic findings. Results: The incidence of small for gestational age was significantly higher in the MSI than ISI group (12.9% vs. 41.2%, P=0.036). The length of resected bowel was significantly longer (1.7 cm vs. 8 cm, P=0.010), and the incidence of short bowel syndrome (SBS) (0% vs. 23.1%, P=0.023) and mortality (3.2% vs. 23.5%, P=0.047) were significantly higher in the MSI than ISI group. However, there was no significant difference between the two groups in terms of high-output stoma, time of full enteral feeding, extrauterine growth retardation, changes of z-score of body weight between admission and discharge and reoperation. Portal vein gas detected by ultrasonography was the only statistically significant predictive factor of extent of involvement (odds ratio= 13.237, P=0.029). Conclusion: SBS and mortality were higher in MSI NEC compared to ISI NEC. However, there was no difference in the time of full enteral feeding and growth between the two groups. Portal vein gas detected by ultrasonography maybe a predictive factor of extent of NEC. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the usefulness of abdominal sonography in the diagnosis of necrotizing enterocolitis (NEC). Methods: We reviewed the medical records of 51 neonates who were diagnosed with NEC in the neonatal intensive care unit at Yeouido St. Mary's Hospital of the Catholic University in Korea between January 2008 and December 2012. The neonates underwent abdominal ultrasonography on the day of their diagnosis and on the third day after diagnosis. Simple abdominal radiography was performed on the same day as the sonography. The neonates were diagnosed with NEC in accordance with the abdominal sonographic findings. Abdominal radiography and sonography were used to assess the NEC stages in the neonates Results: On the day of NEC diagnosis by abdominal sonography, 50 neonates were diagnosed with stage II NEC and 1 was diagnosed with stage III NEC. However, simple radiography diagnosed 49 neonates with stage I NEC, 1 with stage II NEC, and 1 with stage III NEC. On the third day after NEC diagnosis by abdominal sonography, 48 neonates were diagnosed with stage II NEC and 3 were diagnosed with stage III NEC. On the other hand, simple radiography diagnosed 26 neonates with stage I NEC, 24 with stage II NEC, and 1 with stage III NEC. Conclusion: Abdominal sonography can be used as a tool for accurately diagnosing NEC and treating neonates showing ambiguous symptoms during the early stages of NEC. [ABSTRACT FROM AUTHOR]

Purpose: In this single center study, we assessed the timing of presentation of necrotizing enterocolitis (NEC) diagnosed by sonography according to the gestational age. Methods: We retrospectively reviewed the medical records of 49 newborn patients who were diagnosed with NEC (modified Bell's stage II and higher according to abdominal sonography and simple abdominal radiography) and were admitted to the neonatal intensive care unit of St. Mary's Hospital between January 2008 and December 2012. Infants were grouped according to their gestational age (GA): Group I (GA <28 weeks), Group II (GA, 28-32 weeks), Group III (GA, 33-36 weeks), and Group IV (GA ≥37 weeks); early-onset NEC was considered when NEC developed at <14 days of age and late-onset NEC was considered when NEC developed at ≥14 days of age. Results: The number of infants in each group were: Group I (n = 16), Group II (n = 20), Group III (n = 11), and Group IV (n = 2). The mean age at diagnosis of NEC was: Group I (31.6 days), Group II (15.9 days), Group III (11.0 days), and Group IV (2.0 days). Early-onset NEC developed at a mean of 5.5 days of age, whereas late-onset NEC developed at a mean of 36.1 days of age Conclusion: Based on early sonographic diagnosis, infants with lower gestational ages developed NEC at a more advanced postnatal age as compared to more mature infants. However, further studies are needed to understand the etiology of this disease process. [ABSTRACT FROM AUTHOR]

Purpose: In the present study, we aimed to determine the risk factors for the development of cystic periventricular leukomalacia (CPVL) in very low birth weight (VLBW) infants. Methods: We reviewed the medical records of 309 infants weighing less than 1,500 g who were admitted to the neonatal intensive care unit at Hanyang University Medical Center, Seoul from April 2007 to December 2012. Thirty-nine infants died within 28 days of birth. Of the remaining 270 infants, 21 with CPVL established by cranial ultrasonography, and 63 without CPVL, who were matched for gestational age, were enrolled in this study. Univariate and multivariate analyses of maternal, perinatal, and neonatal risk factors for CPVL were performed through retrospective assessment of data collected from the medical records. Results: Necrotizing enterocolitis (NEC ≥stage II: 42.9% vs. 9.5%, P =0.002), cultureproven sepsis (66.7% vs. 34.9%, P =0.021), hypotension with sepsis (33.3% vs. 6.3%, P =0.004), and severe intraventricular hemorrhage (≥grade III: 61.9% vs. 22.2%, P = 0.002) were associated with the development of CPVL on univariate analysis. Using multivariate logistic regression analysis, two variables were found to be statistically significant independent risk factors: NEC (≥stage II: adjusted OR, 5.12; 95% CI, 1.219-21.514; P =0.026) and hypotension with sepsis (adjusted OR, 8.23; 95% CI, 1.194-56.713; P =0.032). Conclusion: NEC (≥stage II) and hypotension with sepsis were associated with an increased risk of developing CPVL in VLBW infants. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants' systemic manifestations were mild or absent, and all of them completely recovered within 2-3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC. [ABSTRACT FROM AUTHOR]