Page 31 of 73 NECROTIC COLOENTERITIS OF NEWBORNS (NCN)
The etiology of this serious illness of newborns is unknown; its main line — an intestines necrosis. Dependence of incidence on racial accessory and a floor is not established. This illness occurs at 1 — 8% of the children hospitalized in intensive care units of newborns. As newborns with very low body weight are especially subject to NEN. the frequency of a disease which increased in recent years demonstrates the best survival of children of this group of high risk.
Patomorfologiya and Pathogeny. Many factors participate in development of a necrosis of a site of a gut, accumulation of gas in a submucosal layer, progressing of the necrosis leading to perforation, sepsis and death. Process is localized mainly in distal department of an ileal gut and proximal department of a large intestine. Believe that such perinatal stresses as asphyxia and a hypothermia, contribute to intestines ischemia. Injury of a mucous membrane, the subsequent infection and a necrosis are promoted also by many other factors. In particular, damage of an endothelium of vessels conducts to a thrombogenesis. Also carry intestines stretching, introduction of umbilical catheters, delay of a blood-groove to etiological factors. Immunoglobulins of breast milk, apparently, do not protect the child from NEN.
Clinical manifestations. The illness usually begins in the first 2 weeks, but can develop also on the second month of life. Meconium separates normally, and the first symptom of a disease — increase in a stomach and stagnation of food in a stomach. Blood in Calais is found in 25% of patients. Often the illness begins imperceptibly, and sepsis develops before there is a suspicion about damage of intestines. The condition of the child quickly worsens, he is in prostration, there is acidosis; shock and the disseminated intravascular blood coagulation can develop.
Diagnosis. The children entering into risk group have to be under the most fixed supervision. On survey roentgenograms it is possible to see a pneumatosis intestinalis — an important diagnostic character of NEN; at 50 — 75% of patients the pneumatosis develops even prior to treatment. A terrible symptom is availability of gas in a portal vein, and the pneumoperitoneum indicates perforation of a gut.
At the differential diagnosis it is necessary to consider specific infections (system or intestinal), impassability and an illness of Girshprunga. An important role in diagnosis is played by radiological and microbiological researches. Anamnestic data about taking place before obstruction of distal department of intestines allow to suspect an illness of Girshprunga, and results of studying of bioptat of a rectum confirm it. The barium enema is contraindicated because of danger to perforate a gut.
Treatment. At suspicion on NEN and at the established diagnosis carry out intensive Important treatments by components the feeding termination, an intestines decompression by means of the gastric tube entered through a nose, intravenous administration of liquids, careful control of acid-base equilibrium and content of electrolytes are. After capture of blood, urine and cerebrospinal fluid begin treatment with antibiotics. If the umbilical catheter is delivered to the child, then it should be removed: at a hypoxia and a hypercapnia of the patient transfer to the managed breath.
Often do survey roentgenograms with the purpose to reveal a pneumatosis intestinalis; define a hematocrit, quantity of thrombocytes, erythrocytes, acid-base equilibrium indicators. Falling of quantity of thrombocytes indicates a possibility of gangrene of intestines.
From the very beginning of a disease of the patient has to be under supervision of the surgeon. Symptoms of perforation and a palpation in an abdominal cavity of soft infiltrate (a sign of a rupture of a wall of a gut) are indications to a resection of a nekrotizirovanny gut. The drainage of an abdominal cavity can be useful in that case when the patient with peritonitis is in a terminal state and cannot sustain bowel resection.
Forecast. Therapeutic treatment is inefficient approximately at 50% of patients with a pneumatosis intestinalis; every second of them perishes. Less than at 10% of patients in a zone of a necrosis strictures develop. When extensive bowel resection is not required, further any disturbances of functions of intestines do not arise.