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Necrotic coloenteritis of newborns - Diseases of digestive organs at children

Table of contents
Diseases of digestive organs at children
Oral cavity
Diseases of teeth
Malformations of the sky and soft tissues of an oral cavity
Diseases of a mucous membrane of an oral cavity and gums
Diseases of lips and language
Sialadens
Digestive tract
Basic reasons of gastrointestinal frustration
Gullet
Atresia and esophageal and tracheal fistula
Guttural and tracheal and esophageal crevice, inborn stenosis of a gullet
Other diseases of a gullet
Stomach and intestines
Peptic ulcer
Inborn hypertrophic pyloric stenosis
Inborn impassability of intestines
Inborn impassability of a duodenum
Disturbances of turn of intestines
Inborn impassability of a small bowel
Inborn megacolon
Diverticulums and duplikatura
The acquired impassability of intestines
Intestines invagination
Foreign bodys of a stomach and intestines
Motive frustration. stomach and intestines
Anomalies of a structure of anorectal area
Infectious diseases of intestines
Nonspecific ulcer colitis
Illness Krone
Necrotic coloenteritis of newborns
The coloenteritis connected with treatment by antibiotics
Gastrointestinal symptoms of anaphylactoid purpura, gemolitiko-uraemic syndrome
Intolerance of food proteins
Eosinophilic gastroenteritis
Absorption disturbance syndromes
Malabsorption
Immunodeficiency and intestines
Syndrome of "a congestive loop"
Syndrome of a short small bowel
Gee's disease
Sprue after acute enteritis
Tropical to a spr
Whipple's illness, intestines lymphangiectasia, Uolmap's illness, idiopathic diffusion defeat of mucous
Enzymopathies and disturbances of mechanisms of transport of nutrients
Irritable colon
Acute appendicitis
Diseases of an anus, direct and large intestine
Tumors of a digestive tract at children
Hernias of a digestive tract at children
Exocrine part of a pancreas
Pancreatitis
Embryonic development of structure and function of a liver
Diagnosis of diseases of a liver
Cholestatic states at babies
Parenchymatous jaundices at children of chest age
Disturbances of a metabolism of a liver and zhelchevydelitelny system
Anomalies of a structure of bilious ways
Cysts of bilious channels
Cholestasia and diseases of a liver connected with completely parenteral food
Medicinal damage of a liver
Ray's syndrome
Chronic hepatitis
Wilson's illness — Konovalova
Indian juvenile cirrhosis
Damages of a liver at chronic colitis
Cirrhosis and chronic liver failure
Portal hypertensia and varicosity of a gullet
Fatty infiltration of a liver
Cholecystitis
Peritoneum diseases
Peritonitis
Peritoneum hernias
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.



 
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