Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1978 Jan;187(1):1–7. doi: 10.1097/00000658-197801000-00001

Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.

M J Bell, J L Ternberg, R D Feigin, J P Keating, R Marshall, L Barton, T Brotherton
PMCID: PMC1396409  PMID: 413500

Abstract

A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.

Full text

PDF
1

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barlow B., Santulli T. V., Heird W. C., Pitt J., Blanc W. A., Schullinger J. N. An experimental study of acute neonatal enterocolitis--the importance of breast milk. J Pediatr Surg. 1974 Oct;9(5):587–595. doi: 10.1016/0022-3468(74)90093-1. [DOI] [PubMed] [Google Scholar]
  2. Barlow B., Santulli T. V. Importance of multiple episodes of hypoxia or cold stress on the development of enterocolitis in an animal model. Surgery. 1975 May;77(5):687–690. [PubMed] [Google Scholar]
  3. Bell M. J., Kosloske A. M., Benton C., Martin L. W. Neonatal necrotizing enterocolitis: prevention of perforation. J Pediatr Surg. 1973 Oct;8(5):601–605. doi: 10.1016/0022-3468(73)90397-7. [DOI] [PubMed] [Google Scholar]
  4. Book L. S., Herbst J. J., Atherton S. O., Jung A. L. Necrotizing enterocolitis in low-birth-weight infants fed an elemental formula. J Pediatr. 1975 Oct;87(4):602–605. doi: 10.1016/s0022-3476(75)80835-3. [DOI] [PubMed] [Google Scholar]
  5. Dudgeon D. L., Coran A. G., Lauppe F. A., Hodgman J. E., Rosenkrantz J. G. Surgical management of acute necrotizing enterocolitis in infancy. J Pediatr Surg. 1973 Oct;8(5):607–614. doi: 10.1016/0022-3468(73)90398-9. [DOI] [PubMed] [Google Scholar]
  6. Egan E. A., Mantilla G., Nelson R. M., Eitzman D. V. A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis. J Pediatr. 1976 Sep;89(3):467–470. doi: 10.1016/s0022-3476(76)80553-7. [DOI] [PubMed] [Google Scholar]
  7. Frantz I. D., 3rd, L'heureux P., Engel R. R., Hunt C. E. Necrotizing enterocolitis. J Pediatr. 1975 Feb;86(2):259–263. doi: 10.1016/s0022-3476(75)80485-9. [DOI] [PubMed] [Google Scholar]
  8. Hill H. R., Hunt C. E., Matsen J. M. Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis. J Pediatr. 1974 Sep;85(3):415–419. doi: 10.1016/s0022-3476(74)80133-2. [DOI] [PubMed] [Google Scholar]
  9. Hillman L. S., Goodwin S. L., Sherman W. R. Identification and measurement of plasticizer in neonatal tissues after umbilical catheters and blood products. N Engl J Med. 1975 Feb 20;292(8):381–386. doi: 10.1056/NEJM197502202920801. [DOI] [PubMed] [Google Scholar]
  10. Leonidas J. C., Hall R. T. Neonatal pneumatosis coli: a mild form of neonatal necrotizing enterocolitis. J Pediatr. 1976 Sep;89(3):456–459. doi: 10.1016/s0022-3476(76)80550-1. [DOI] [PubMed] [Google Scholar]
  11. Lloyd J. R. The etiology of gastrointestinal perforations in the newborn. J Pediatr Surg. 1969 Feb;4(1):77–84. doi: 10.1016/0022-3468(69)90186-9. [DOI] [PubMed] [Google Scholar]
  12. Richmond J. A., Mikity V. Benign form of necrotizing enterocolitis. Am J Roentgenol Radium Ther Nucl Med. 1975 Feb;123(2):301–306. doi: 10.2214/ajr.123.2.301. [DOI] [PubMed] [Google Scholar]
  13. Roback S. A., Foker J., Frantz I. F., Hunt C. E., Engel R. R., Leonard A. S. Necrotizing enterocolitis. An emerging entity in the regional infant intensive care facility. Arch Surg. 1974 Aug;109(2):314–319. doi: 10.1001/archsurg.1974.01360020174034. [DOI] [PubMed] [Google Scholar]
  14. Smith D. H., Van Otto B., Smith A. L. A rapid chemical assay for gentamicin. N Engl J Med. 1972 Mar 16;286(11):583–586. doi: 10.1056/NEJM197203162861106. [DOI] [PubMed] [Google Scholar]
  15. Speer M. E., Taber L. H., Yow M. D., Rudolph A. J., Urteaga J., Waller S. Fulminant neonatal sepsis and necrotizing enterocolitis associated with a "nonenteropathogenic" strain of Escherichia coli. J Pediatr. 1976 Jul;89(1):91–95. doi: 10.1016/s0022-3476(76)80939-0. [DOI] [PubMed] [Google Scholar]
  16. Stevenson J. K., Graham C. B., Oliver T. K., Jr, Goldenberg V. E. Neonatal necrotizing enterocolitis. A report of twenty-one cases with fourteen survivors. Am J Surg. 1969 Aug;118(2):260–272. doi: 10.1016/0002-9610(69)90129-9. [DOI] [PubMed] [Google Scholar]
  17. Stevenson J. K., Oliver T. K., Jr, Graham C. B., Bell R. S., Gould V. E. Aggressive treatment of neonatal necrotizing enterocolitis: 38 patients with 25 survivors. J Pediatr Surg. 1971 Feb;6(1):28–35. doi: 10.1016/0022-3468(71)90664-6. [DOI] [PubMed] [Google Scholar]
  18. Sántulli T. V., Schullinger J. N., Heird W. C., Gongaware R. D., Wigger J., Barlow B., Blanc W. A., Berdon W. E. Acute necrotizing enterocolitis in infancy: a review of 64 cases. Pediatrics. 1975 Mar;55(3):376–387. [PubMed] [Google Scholar]
  19. Torma M. J., DeLemos R. A., Rogers J. R., Jr, Diserens H. W. Necrotizing enterocolitis in infants. Analysis of forty-five consecutive cases. Am J Surg. 1973 Dec;126(6):758–761. doi: 10.1016/s0002-9610(73)80065-0. [DOI] [PubMed] [Google Scholar]
  20. Touloukian R. J., Kadar A., Spencer R. P. The gastrointestinal complications of neonatal umbilical venous exchange transfusion: a clinical and experimental study. Pediatrics. 1973 Jan;51(1):36–43. [PubMed] [Google Scholar]
  21. Touloukian R. J., Posch J. N., Spencer R. The pathogenesis of ischemic gastroenterocolitis of the neonate: selective gut mucosal ischemia in asphyxiated neonatal piglets. J Pediatr Surg. 1972 Apr;7(2):194–205. doi: 10.1016/0022-3468(72)90496-4. [DOI] [PubMed] [Google Scholar]
  22. Weinstein W. M., Onderdonk A. B., Bartlett J. G., Louie T. J., Gorbach S. L. Antimicrobial therapy of experimental intraabdominal sepsis. J Infect Dis. 1975 Sep;132(3):282–286. doi: 10.1093/infdis/132.3.282. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES