NECROTIZING ENTEROCOLITIS - A 12-YEAR RET ROSPECTIVE

Necrotizing enterocolitis (NEC) is the most relevant intestinal acquir ed complication during the neonatal period. Due to the improvements in perinatal medicine during the last decade, we wanted to work out poss ible differences in the incidence, diagnosis and clinical courses of N EC during a 12 years period. Patients and methods All premature or ter m newborns were eligible for the study, if a necrotizing enterocolitis greater-than-or-equal-to stage 2a according to Bell was diagnosed bet ween January 1980-December 1991. Results During the study period, 90 p reterm or term newborns were treated for necrotizing enterocolitis, 19 infants were admitted to our hospital for therapy of established NEC from other hospitals. Fourtyfive infants had a birthweight of less-tha n-or-equal-to1500 g. During the years 1987-1991 there was an increase in the incidence (4-12/year, median 9/year, compared to 0-6, median 3/ year during the period 1980-1986). This was paralleled by an increase in very low birthweight infants admitted to the NICU (1980-1986: 35-45 /year, 1987-1991: 83-108/year). Prominent clinical signs: abdominal di stension (85 infants), increased gastric residuals (72), bright blood from rectum (56). Median time of manifestation in infants less-than-or -equal-to30 weeks was 17 days, for infants of 31-34 weeks 8 days and f or infants of greater-than-or-equal-to35 weeks of gestation 4 days. El even infants were fed parenterally exclusively before NEC, 12 infants received exclusively breast milk, 67 formula. Surgical treatment was i ndicated in 51 infants (indication: intestinal perforation or peritoni tis diagnosed by abdominal paracentesis). Seventyone infants survived, in 17 infants who died, NEC or secondary disorders were the main caus e. Conclusion With increasing numbers of very preterm infants, the rel evance of NEC becomes more and more important. Concepts of prevention and early diagnosis further have to be worked out.