NECROTIZING ENTEROCOLITIS

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1. NECROTIZING ENTEROCOLITIS PRESENTED BY, MS. L.SOUNDARYA M.SC.NURSING (PEDIATRICS)

2. NEC characterized by necrosis of the intestinal wall, is a serious life threatening condition that is being diagnosed with increasing frequency in premature infants

3. ETIOLOGY

4. Perinatal asphyxia Low apgar score IRDS Congenital heart disease sepsis

5. Ischemia/ hypovolemia of the intestinal tract that is associated with; Hypotension Use of umbilical catheters Exchange transfusion hypertonic foods Medications or fliuds

6. PATHOPHYSIOLOGY

7. Hypoxia, acidosis, hypoglycemia, low cardiac output, hypothermia Decreased splanchnic blood flow Hypertonic feeding –mucosal edema, ulceration Intestinal colonization with E.Coli , Klebshella Invasive infection by bowel flora

8. Bacterial invasion of portal system and lymphatic bowels Transdural bowel necrosis Perforation Collapse Sepsis Endotoxin release Pneumotosis intestinalis Portal gas, septicemia

9. CLINICAL PRESENTATION

10. DIAGNOSTIC EVALUATION

11. History collection Physical examination Blood test- bilirubin , serum electrolytes , blood sugar level, blood culture Stool culture/ sensitivity Abdominal x-ray/ USG Hepatic ultrasonography

12. NURSING MANAGEMENT

13. Oral feeding should be discontinued peripheral IV fluids can be started NG tube –to remove stomach contents Antibiotic therapy Psychosocial support Hydrocorticosone may be given Regular check up of vital signs Prevent cross infection.

14. Outcomes Re- occurance of the disease PREVENTION Fresh breast milk feeding to all neonates