Necrotizing enterocolitis (NEC) is the most common, life-threatening disease of the intestines of premature infants and newborns. It is an inflammation of the intestine, which can affect one or more sections of the intestine. It occurs in around 5-10% of extremely premature babies (birth weight under 1500 g), the exact cause is still unclear. It is assumed that the immature immune system of the gastrointestinal tract of premature babies plays a major role in the development of NEC.

Various risk factors have been described, but none of them is of decisive importance.

The children present with general signs of illness, such as lethargy. Overall, these symptoms resemble those of blood poisoning ("sepsis"). Patients may appear "dirty gray" due to reduced blood flow to the skin. There are also respiratory and circulatory disorders.

There is an increase in stomach residue and poorer food tolerance. The abdominal wall of small patients is distended and painful, the muscles of the abdominal wall are therefore tense. The intestinal loops, which become very sluggish, may also be visible underneath. The consistency of the stool may change and blood may also be present.

In order to diagnose NEC, close-meshed physical examinations with ultrasound examinations of the abdomen, multiple blood tests and X-ray examinations are necessary. These reveal elevated infection parameters in the blood. Depending on the severity of the clinical picture, sonography reveals thickened intestinal walls and dilated intestinal loops. Gas bubbles in the portal vein (pneumatosis hepatis) and in the intestinal wall (pneumatosis intestinalis) are typical of NEC.

If the intestinal inflammation has broken through the intestinal wall (perforation), "free air" can be seen in the abdominal cavity on the X-ray; in some cases, sonography nowadays already allows conclusions to be drawn about free air in the abdomen. Nevertheless, an X-ray of the abdomen is considered the gold standard for confirming a perforation.

If there is a clinical suspicion of NEC, the first step is to try to get the intestinal inflammation "under control" with conservative measures such as abstinence from food, antibiotics and stabilization of breathing and circulation. If this is not successful or if the intestinal inflammation has already broken through the intestinal wall, the child usually has to undergo surgery.

All children suspected of having NEC are cared for on our pediatric surgical/neonatal intensive care unit (ward 69) in very close cooperation with our neonatologists. This interdisciplinary care and assessment of young patients is crucial for optimal treatment and for assessing whether and when a child requires surgery.

Repeated, close-meshed physical examinations and further diagnostics (blood tests, swabs for bacteria, ultrasound and X-ray examinations) are carried out on affected infants. Attempts are made to get the NEC "under control" with circulation-supporting medication and antibiotics. However, it often happens that the intestinal inflammation is so severe that a general inflammation of the peritoneum develops (peritonitis) or the intestinal wall ruptures. We then have to operate on your child.

 

The operation can be performed either in the operating room of the children's hospital or in the intensive care unit itself. It should be performed at an early stage so that as little of the affected bowel as possible has to be removed. We make an incision of a few centimeters across the upper abdomen. The entire bowel is then carefully examined for signs of inflammation. Parts of the bowel that are severely affected by the inflammation must be removed. Due to the inflammation and the vulnerability of the bowel, the two ends of the bowel that are adjacent to the removed part of the bowel cannot be sutured together again directly afterwards (anastomosis). In most cases, an artificial bowel outlet (enterostomy) must therefore be temporarily created so that the intestinal inflammation can heal. The artificial anus can then be repositioned around 6 weeks later, depending on the current weight, as part of a second operation. Before repositioning, the small patients are given a contrast medium image of the artificial anus. The second operation can then be carried out as planned.

All sutures are made of absorbable material. The stitches do not need to be removed later. Scarring depends on the individual's disposition. As the incision takes into account the so-called cleavage lines of the skin and newborns have better wound healing compared to adults, the scars are often less visible later than expected.

NEC is a life-threatening disease. Despite modern neonatal and surgical treatment methods, 15-30% of premature babies with NEC still die. Follow-up care depends on the age of your child and how long your child needs to stay in the neonatal intensive care unit until it can feed itself again and gain weight.