De Bernardo Giuseppe, Sordino Desiree, De Chiara Carolina, Riccitelli Marina, Esposito Francesco, Giordano Maurizio, Tramontano Antonino
Department of Mother's and Child's Health, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Department of Emergency, Santobono-Pausilipon Children Hospital, Napoli, Italy.
Curr Pediatr Rev. 2019;15(2):125-130. doi: 10.2174/1573396314666181102122626.
Necrotizing enterocolitis is the most common cause of the postnatal critical conditions and remains one of the dominant causes of newborns' death in Neonatal Intensive Care. The morbidity and mortality associated with necrotizing enterocolitis remains largely unchanged and the incidence of necrotizing enterocolitis continues to increase. There is no general agreement regarding the surgical treatment of the necrotizing enterocolitis.
In this paper, we want to evaluate the results obtained in our centre from different types of necrotizing enterocolitis's surgical treatment and to analyse the role of traditional X-ray versus ultrasound doppler imaging in the evolutionary phases of necrotizing enterocolitis. The study was conducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon in Naples from January 2010 to December 2016. Patients were monitored by hematochemical examinations and radiological orthostatic exams every 12 hours, so that they had a surgical opportunity before intestinal perforation occurred. Ultrasonography was performed to monitor preterm infants who were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging.
They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g (N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46 patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment. In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a 'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing enterocolitis, when the radiographic examination shows only a specific dilation of the loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness of wall sections.
Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegration of liquids but above all with timely diagnosis, aimed to discover early prodromic phases of wall damage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only when barrier damage is detected while US provides real-time imaging of abdominal structures, highlighting some elements that are completely excluded by radiograph.
坏死性小肠结肠炎是产后危急情况的最常见原因，仍是新生儿重症监护中新生儿死亡的主要原因之一。与坏死性小肠结肠炎相关的发病率和死亡率基本保持不变，而坏死性小肠结肠炎的发病率持续上升。关于坏死性小肠结肠炎的外科治疗尚无普遍共识。
在本文中，我们希望评估我们中心从不同类型的坏死性小肠结肠炎外科治疗中获得的结果，并分析传统X线与超声多普勒成像在坏死性小肠结肠炎演变阶段的作用。该研究于2010年1月至2016年12月在那不勒斯的桑托博诺 - 帕西利蓬综合医院急诊重症监护病房进行。每12小时通过血液化学检查和放射学立位检查对患者进行监测，以便在肠穿孔发生前给予他们手术机会。对入住新生儿重症监护病房且在贝尔分期I期出现坏死性小肠结肠炎症状的早产儿进行超声检查。
招募了75例处于贝尔分期I - III期且有坏死性小肠结肠炎症状的早产儿，他们接受了手术或药物治疗。对于出生体重>1500g的婴儿（N = 30），剖腹术和坏死肠段切除术通常是我们首选的方法。在46例患者中，我们在切除孤立的坏死肠段后进行了一期吻合。对于有多个坏死区域且肠活力可疑的患者，在24至48小时后安排进行“二次探查”以重新评估肠道。在坏死性小肠结肠炎的初始阶段，当放射学检查仅显示肠袢的特定扩张时，超声检查显示出越来越多的特异性征象，如肠壁增厚、壁层回声改变、壁灌注增加、壁层内单个或散在的气载微气泡。
坏死性小肠结肠炎的最佳手术治疗始于充分的抗生素治疗、液体补充，但最重要的是及时诊断，旨在通过超声这一基本工具早期发现肠壁损伤的前驱阶段。腹部X线摄影仅在检测到屏障损伤时显示特异性征象，而超声提供腹部结构的实时成像，突出了一些X线摄影完全排除的要素。
