Kosloske A M, Musemeche C A
University of New Mexico School of Medicine, Albuquerque.
Clin Perinatol. 1989 Mar;16(1):97-111.
Necrotizing enterocolitis is the most common gastrointestinal emergency in the newborn. The syndrome strikes premature infants during the first 2 weeks of life. Abdominal distention, lethargy, and feeding intolerance are early signs of NEC that may progress to gastrointestinal bleeding and hemodynamic instability. The radiographic hallmark of NEC is pneumatosis intestinalis (air in the bowel wall). The ileum and colon are the usual sites of crepitant intestinal necrosis, leading frequently to perforation. In spite of appropriate medical therapy, about half of the infants with NEC develop intestinal gangrene or perforation and require surgery, consisting of bowel resection and enterostomy formation. The most common late complication, intestinal stricture, occurs in 15 to 35 per cent of recovered infants. Overall mortality from NEC ranges from 20 to 40 per cent. The etiology of NEC is poorly understood and is considered to be multifactorial, related to ischemia, bacterial colonization, and formula feedings in a susceptible infant. Future progress in the treatment of NEC may be achieved by earlier detection of necrosis, modification of gastrointestinal flora, or by bolstering the deficient gastrointestinal immune mechanisms of the premature neonate.
坏死性小肠结肠炎是新生儿最常见的胃肠道急症。该综合征在出生后前2周侵袭早产儿。腹胀、嗜睡和喂养不耐受是坏死性小肠结肠炎的早期症状，可能进展为胃肠道出血和血流动力学不稳定。坏死性小肠结肠炎的影像学特征是肠壁积气（肠壁内有气体）。回肠和结肠是发生气性肠坏死的常见部位，常导致穿孔。尽管进行了适当的药物治疗，约一半坏死性小肠结肠炎患儿仍会发生肠坏疽或穿孔，需要手术治疗，包括肠切除和造口术。最常见的晚期并发症是肠狭窄，发生在15%至35%康复的患儿中。坏死性小肠结肠炎的总体死亡率为20%至40%。坏死性小肠结肠炎的病因尚不清楚，被认为是多因素的，与易患婴儿的缺血、细菌定植和配方奶喂养有关。坏死性小肠结肠炎治疗的未来进展可能通过更早发现坏死、改变胃肠道菌群或增强早产儿缺乏的胃肠道免疫机制来实现。
