NECROTIZING ENTEROCOLITIS: WHAT ASPECTS IN 2017?

Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonatal intensive care units, making it one of the leading causes of neonatal mortality despite the progress of neonatal resuscitation. It is more prevalent in lower gestational age and lower birth weight groups. Objective: To describe the epidemiological, clinical, radiographic, therapeutic features and outcome of patients presenting NEC during hospitalization in a Tunisian Neonatal Resuscitation and Intensive Care Unit. Material & Methods: A retrospective descriptive study of patients presented NEC in our Neonatal Resuscitation and Intensive care unit over a two years period (March 2015 - March 2017). Results: We collected 17 patients, 8 male and 9 female. 14 patients were born prematurely. The median weight at birth was 1500 g with extremes between 1100 g and 1980 g. 9 patients were small for gestational age. The mean Apgar at 5 minutes was 6 ± 3. 6 patients had perinatal asphyxia. 15 patients had received an empiric antibiotic therapy at birth. 16 had an umbilical venous catheter. 3 patients had a maternofoetal infection and 7 patients had a healthcare associated infection. 11 patients required mechanical ventilation at birth with a median duration of 5 days and extremes between 2 and 12 days. 10 patients presented metabolic acidosis. Enteral feeding was started after 72 hours of life: 9 patients were breastfeeding and 7 patients had received an infant formula. Clinically, abdominal distension was noted in 13 cases, feeding residuals in 13 cases, apnea in 10 cases, abdominal tenderness in 8 cases and bradycardia in 4 cases. Symptoms were considered severe in 5 cases with schock. Rectal bleeding was noted in 3 cases. Abdominal X-ray was normal in 10 cases. It showed bowel dilatation in 6 cases, thickening of bowel wall in 3 cases, pneumatosis intestinalis in 2 and free intraperitoneal gas indicative of intestinal perforation in one case. According to the ell's criteria, 10 cases were classified as stage I, 6 as stage II and 1 as stage III. 15 patients underwent broad spectrum antibiotherapy, 12 in absolute diet. Mechanical ventilation was used in 11 cases. Only one patient with intestinal perforation underwent surgery. Evolution was favourable in 13 cases, 4 patients died. Conclusion. NEC represents only 8 to 12% of neonatal infections, but it remains a serious lifethreatening condition for newborns. We illustrate the risk factors of this disease and the different clinical features. Despite advancements in the knowledge and understanding of the pathophysiology of NEC, there is currently no universal prevention measure for this serious and often fatal disease. [ABSTRACT FROM AUTHOR]