Abstract | Optimization of Diagnosis and Treatment of Necrotizing Enterocolitis In Newborns

Author: Yana Pryshvytsyna

Scientific advisor: Spahi O.V. Ph.D.

Department of Pediatric Surgery and Anesthesiology

Zaporizhzhia State Medical University

According to domestic and foreign researchers, the diagnosis of NEC is difficult because there are currently   no  specific diagnostic markers, and the  diagnosis is based on  general  clinical, laboratory and instrumental methods. Due to that  in most  cases NEC is diagnosed when  there is perforation of the intestinal wall.

Materials and methods: In the clinic of pediatric surgery and anesthesiology from ZSMU from 2012 to 2018, 23 patients were diagnosed with necrotizing enterocolitis, including 15 (65.2%) boys and 8 (34.8%)  girls. Among the  study group,  preterm infants with weights at birth were  predominantly less than 1500g and accounted for 74%  (16  patients).  Among  the  concomitant  diseases  in 12  (52,2%) patients – congenital malformations, in 7 (30,4%) – birth trauma, in 21 (91,3%) – sepsis. One applied international classification of the  NEC for Bell (1978) according to which among the  study group newborns with stage III NEC made up 47.8%, from stage II – 34.7%  and from I – 17.5%. One used general-clinical, laboratory, radiological, echographic and endoscopic during research. The results: Among X-ray signs in children with I and II stages of NEC predominates pneumatosis of the intestinal wall-75%, in children with stage III – pneumoperitoneum in 90%  of cases. The main echographic signs  in  patients  with  I  and II  stages of  the  disease were  the  presence of  hyperechogenic “microvesicles” in the portal vein and the presence of changes in the parenchyma of the liver in the form  of hyperechogenic “plaques”. In children with stage III  NEC –  the  presence of fluid in the abdominal cavity and dense intestinal infiltration. The beginning of the disease in 90% of children with stage III NEC – 5-6 days after birth, and 81.8%  of children in stages I and II – 10-11 days. Surgical tactics in the treatment of NEC was used in 91.3%  of cases. In 19% of patients, primary laparotomy was performed, diagnostic laparoscopy was carried out in 71.5%  of patients, diagnostic laparoscopy in 9.5%, which in all cases required conversion. In the early postoperative period,  2 (9.5%) children had  complications in the  form of postoperative bleeding, and 7 (33.3%)  – prolonged peritonitis. In the   remote  postoperative  period   –   intestinal  adhesion  obstruction  in  3   (14.3%)   patients. Unfortunately, despite the treatment, fatalities were observed in 43.5%  of children.

Conclusions:  Thus,  early  diagnosis  of  necrotizing  enterocolitis  leads  to  a reduction  of complications in the early and remote postoperative period and significantly reduces the number of fatal cases.

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