Neutropenic enteropathy

Neutropenic enteropathy (NE) is used to describe the inflammation of the bowel in neutropenic patients under aggressive chemotherapy, mainly for lymphoproliferative and hematologic malignancies. Surgical intervention may be required in patients with the advent of the disease. We report our experience in 7 children with NE who had to be treated surgically. Absolute neutrophil counts were less than 1000/mm3 in all, with positive blood cultures in five patients. Four patients recovered with rapid resolution of neutropenia, while three patients died with persistent neutropenia.     

Enterocolitis in Hirschsprung's disease

During the 5 years 1985–1989, 24 (32%) of 76 patients treated for Hirschsprung's disease (HD) developed enterocolitis, this being present at the time of diagnosis in 10 (13%) infants, 7 of whom were neonates. HD presented as necrotizing enterocolitis in 5 neonates, 4 of whom were premature. The enterocolitis developed postoperatively in 14 (18%) patients, in 7 after an enterostomy and in 7 after a pull-through procedure. Recurrent episodes of enterocolitis occurred in 4 of the patients who developed postoperative enterocolitis. The risk of enterocolitis was increased in girls, in patients with associated Down's syndrome, those with a family history of HD, and those managed by an endorectal pull-through procedure. The Duhamel procedure was associated with a low (5%) incidence of postoperative enterocolitis. Long-segment aganglionosis was not associated with an increased risk of enterocolitis and preoperative enterocolitis conferred no increased risk of postoperative enterocolitis.     

新生儿坏死性小肠结肠炎的研究进展

坏死性小肠结肠炎（NEC）是新生儿常见而严重的胃肠道急症。目前多认为早产、喂养不当与细菌移位、缺血后再灌注损伤、炎症介质作用等是NEC最重要的危险因素，这些危险因素共同作用导致NEC发生。NEC的预防主要应针对病因，如促进肠上皮细胞成熟、维持正常肠黏膜屏障和肠微生态系统平衡及抑制炎性介质释放和细菌移位的发生。表皮生长因子及肝素结合表皮生长因子、益生菌、谷氨酰胺和精氨酸、人类粒细胞集落刺激因子等对预防NEC的发生有一定作用。     

Loperamide Associated Necrotising Enterocolitis

ABSTRACT. Two cases of necrotising enterocolitis (NEC) occurring in infants beyond the neonatal period were reported. They did not have any predisposing factors to NEC but both had paralytic ileus after loperamide therapy for their mild diarrhoea prior to the onset of NEC. The possible role of loperamide in the pathogenesis of NEC was discussed.     

Enterocolitis complicating Hirschsprung's disease

Enterocolitis remains a relatively common complication of Hirschsprung's disease with significant morbidity and mortality. The etiology of Hirschsprung's enterocolitis (HEC) is multifactorial and remains poorly understood. Preventative measures and better treatment modalities will evolve out of a better understanding of the underlying pathophysiology. Prompt recognition of HEC allows early intervention and a potential reduction in disease severity and mortality. This review of HEC describes the epidemiology, clinical and pathological features and current best practice in management. Some of the areas of research into etiology and treatment are discussed.     

Cytomegalovirus Enterocolitis in a Term Neonate

Background

Cytomegalovirus (CMV) enterocolitis is rare in term neonates.

Case characteristics

A term newborn with persistent pneumonia from birth developed enterocolitis on day 18 of life.

Outcome

Polymerase chain reaction (PCR) for CMV DNA was positive in urine sample. Antiviral therapy for six weeks resulted in successful treatment without any stricture formation.

Message

CMV enterocolitis should be considered as a differential diagnosis in atypical cases of necrotizing enterocolitis in neonates.

     

Serum Acute Phase Reactants in Necrotizing Enterocolitis

ABSTRACT. The serum acute phase reactants, C-reactive protein (CRP) and orosomucoid, rose significantly within 24 to 48 hours of presentation in infants with definite necrotizing enterocolitis (NEC) compared with the levels in infants with symptoms who tolerated early reintroduction of enteral feeds. A serum CRP value >10 mg/l within 48 hours identified infants with definite NEC with a 92% sensitivity and an 81% specificity. Serum CRP values remained elevated at 7 to 10 days in 4 infants with late septicaemia and in 4 of 5 infants with abscess or early stricture requiring surgery. Serum acute phase reactants are a potentially valuable adjunct to clinical assessment in the management of infants with suspected NEC.     

Neutropenic enterocolitis in children with acute lymphoblastic leukemia

Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. During the period 1990-1995, 180 children were treated at the authors' center for acute lymphoblastic leukemia using a standard chemotherapy protocol. Among them, 11 children (6.1%) aged 4 to 12 years, were diagnosed clinically to have neutropenic enterocolitis. Eight had severe neutropenia (absolute neutrophil count < 10(8)/L and 5 had prolonged neutropenia (> 7 days duration). The symptoms included diffuse abdominal pain (10 children), oral mucositis (7), hematochezia (7), diarrhea (6), hematemesis (5), and right lower quadrant tenderness (4). Three children had radiological evidence of free intraperitoneal gas and an additional 3 children were found on surgical exploration to have cecal perforation. Laparotomy was performed on 8 children (73%), 4 of whom survived. Among the 3 children managed conservatively, 1 died awaiting surgical exploration, while the other 2 did well. The overall survival was 55%. The authors recommend an approach to management that respects the heterogeneity of the disease.     

Neonatal Necrotizing Enterocolitis: Radiological Manifestations

The radiographic manifestations of necrotizing enterocolitis (NEC) were reviewed in 44 infants. As the clinical presentation of NEC could often not be distinguished from sepsis and/or surgical abdominal problems, abdominal X-ray is by far the most sensitive test for the presence of this disease. Nonspecific radiological findings which frequently accompanied or preceded the appearance of intramural gas include bowel distension, a foamy pattern and asymmetry of gas pattern. The presence of these findings is an indication to repeat radiological abdominal examinations as an adjunct in the early diagnosis of NEC. The radiological hallmark of NEC is intramural gas, though this may be absent in infants with fulminating disease. If pueumoperitoneum occurs, it is diagnosed almost always at the onset or within 24 hours of the disease. Portal venous gas may be a transient sign and is not as ominous as previously reported. Barium studies are not justified in the acute disease but the high incidence of intestinal stricture in survivors may warrant a contrast study during the recovery phase.     

Risk Factors and Outcome in Neonatal Necrotising Enterocolitis

Objectives

To analyze multiple risk factors of necrotizing enterocolitis (NEC) and the outcome.

Methods

Hundred neonates with NEC were compared with 100 normal neonates matched for sex, gestation and weight. Their data including antenatal, natal, course of illness, hospital stay, progress and outcome were collected. Univariate analysis and logistic regression were used to analyze the risk factors.

Results

Mean age of onset of NEC was 2.35?±?1.11 d. Stage I, II and III were noted in 48 %, 39 % and 13 % of cases respectively. Most common clinical features were abdominal distension (85 %) and feed intolerance (70 %). Important risk factors associated with NEC were sepsis, top feeding, perinatal asphyxia, respiratory distress and mechanical ventilation. Antenatal steroids and breast feeding had beneficial effect. No association was found with occurrence of NEC and cyanotic heart disease or administration of H₂ blockers. Outcome in stage III was very poor.

Conclusions

Early identification of risk factors and appropriate intervention may reduce the incidence and improve the outcome in NEC.     

The Haematology of Neonatal Necrotizing Enterocolitis

The haematology of forty-four infants with necrotizing enterocolitis (NEC) has been reviewed. Normal values for neutrophil, band cell and platelet counts as well as coagulation profiles have been defined for normal term and preterm infants at varying postnatal ages. In NEC, the absolute neutrophil count was of no diagnostic or prognostic significance but serial counts were useful in following the course of disease process. Band cell and platelet counts were strong predictors of onset of disease and both were significantly different in infants who died compared with those who survived the disease. Disseminated intravascular coagulation occurred in 11% of cases of NEC, all of whom died. Hypovolaemic shock preceded NEC in 5 infants and 3 infants had preexisting polycythaemia. Severe thrombocytopenia was treated with platelet infusions. Exchange transfusion was carried out for disseminated intravascular coagulation.     

新生儿坏死性小肠结肠炎的外科处理

目的 探讨新生儿坏死性小肠结肠炎外科手术指征、手术方法及术后并发症的预防。方法 回顾性分析1995年1月～2003年1月外科处理的24例新生儿坏死性小肠结肠炎的资料。结果 全部病例治愈18人，死亡6人，治愈率75％。结论 选择合适的手术时机及手术方法可以减少术后并发症的发生，提高治愈率。