Necrotizing Enterocolitis PDF

Preview

Summary

Professor Rounds-Stanley...

Description

Necrotizing Enterocolitis (NEC) Definition: Potentially life-threatening inflammatory disease of the intestinal tract that occurs primarily in premature infants. NEC is one of the most common GI disorders that affects infants in the NICU Etiology:  Affects up to 7% of VLBW infants and is associated w/ a mortality rate of 15%-30%  Occurs most often in the ileum  Early aggressive enteral formula feeding of premature infants is avoided b/c of the  incidence of the disease in these cases  Human milk has been shown to protect against the disease  Multifactorial (intestinal ischemia, bacterial, or viral infection)  Premature infants decreased immune response and greater risk for infection  Immaturity of the GI mucosa Pathophysiology:  Vascular compromise  hypoxia and ischemia  reduced blood flow to the bowel  necrosis of the bowel mucosa  Damaged bowel stops secreting protective enzymes  gas forming bacteria invades necrotic tissue  This bacterial invasion further damages the intestinal mucosa by releasing bacterial toxins and gas  abdominal distention  The infant is at risk for intestinal perforation Clinical manifestations:  Generally occur during the second week of life after enteral feedings are started but NEC can develop before feedings are started, after several weeks of life, and long after feedings are started  Infant may initially show signs of feeding intolerance ( gastric residuals, vomiting, irritability, and abd distention)  These signs are caused by inflammation and dilation of the bowel and accumulation of gas in the intestine  Bloody diarrhea may be present b/c of the hemorrhagic bowel  As it progresses may present w/ lethargy, episodes of apnea and bradycardia as infant develops sepsis Diagnostic tests:  Dx is made by characteristic clinical findings and the presence of free peritoneal gas  Abdominal radiographs (show dilated bowel loops, bowel distention, bowel wall thickening)  Lab data reveal anemia, leukopenia, leukocytosis, thrombocytopenia, electrolyte imbalance, and metabolic or respiratory acidosis  Blood cultures are positive for the organism present Clinical therapy:  Requires prompt intervention to decrease the morbidity and mortality associated w/ illness  Tx includes bowel rest (NPO), gastric decompression w/ nasogastric suction and antibiotic therapy  The infant will need CVA to provide nutrition  Serial radiographs of the abdomen to detect worsening or resolution of the disease process  Perforation or necrosis of the bowel necessitates surgical resection of the bowel  Ileostomy or colostomy may be performed  All cases of NEC are tx w/ strict enteric precautions to prevent spread of infection to other premature infants on unit  Supplementation w/ probiotics can help prevent it Nursing diagnoses:  Infection, Risk for r/t to presence of organisms  Fluid Volume: Deficient, Risk for r/t to NPO status  Perfusion: Gastrointestinal, Risk for Ineffective r/t vascular compromise  Nutrition, Imbalanced: Less than Body Requirements r/t disease process and NPO status  Attachment, Risk for Impaired Parent/Infant r/t critically ill status of newborn Nursing interventions:  If infant is receiving enteral feedings, observe for feeding intolerance by aspirating gastric residual

     

Measure abdominal circumference and assess bowel sounds in preemie or high-risk infant q4-8h Provide comfort (holding, cuddling, provide pacifier) Educate parents on ostomy care if applicable Emphasize importance for follow up to check weight and developmental progress Feedings are gradually reestablished once bowel function returns Maintain skin integrity and assess for infection

Complications:  Sepsis  Short bowel syndrome  Strictures  Cholestasis (disruption of bile flow) MOST COMMON occurs within 2 weeks of TPN initiation; characterized by hyperbilirubinemia, hepatomegaly, and elevated aminotransferase  Impaired nutrition and growth  Delayed developmental performance...