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Necrotising Enterocolitis

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Necrotising Enterocolitis. Anne Aspin 2005. What is it? ... Raised CRP. Pneumoperitoneum. Collapse, ventilation. Abdominal drain. Surgery, stoma's ... – PowerPoint PPT presentation

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Title: Necrotising Enterocolitis


1
Necrotising Enterocolitis
  • Anne Aspin 2005

2
What is it?
  • Infection of the mucosal lining of the bowel
  • Lactobacilli
  • Clostridium
  • Unknown

3
Who does it effect?
  • Maternal factors
  • prematurity
  • Hypoxic episodes
  • Cardiac anomaly
  • Exchange transfusion
  • Umbilical line near mesenteric artery
  • High osmolarity feeding
  • Increasing feeds quickly

4
Signs and symptoms
  • Change in behaviour
  • Subtle signs
  • Lethargy
  • Increasing naso-gastric aspirates
  • Labile temperature, labile blood sugars
  • Vomiting, bile later
  • Blood in stools
  • Abdominal distension

5
Later
  • Mottled, grey, capillary refill lt4 secs
  • Apnoeic
  • Bradycardia
  • Oxygen requirement
  • Abdominal tenderness
  • Oedema
  • Dilated abdominal veins, dilated loops of bowel
  • Flare around umbilicus

6
Even later
  • Thrombocytopenia
  • Raised CRP
  • Pneumoperitoneum
  • Collapse, ventilation
  • Abdominal drain
  • Surgery, stomas
  • Short bowel

7
Grading
  • Grade 1
  • Grade 2
  • Grade 3
  • Grade 4

8
What to do
  • Large ng tube, aspirate and free drainage
  • Nil by mouth
  • IVI, Antibiotics
  • Blood sugar monitoring
  • Sepsis screen. Blood gas, FBC, U/Es, Blood
    cultures
  • Urine MC/S, CXR, AXR

9
Surgical intervention
  • When perforated
  • When conservative treatment failing
  • Strictures, adhesions

10
Stoma
  • Immediate post-op
  • Stoma care
  • Stomal complications

11
Enteral feeding
  • Feeding
  • Long term TPN
  • Short bowel
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