The dangers of necrotizing enterocolitis

The article is professionally consulted by Specialist Doctor I Dong Xuan Ha - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International Hospital.

Necrotizing enterocolitis is a common condition in premature babies, many cases are brought to the hospital requiring surgery and long-term treatment. Without early detection and prompt treatment, neonates with necrotizing enterocolitis may die rapidly or suffer long-term complications of the disease.

Necrotizing enterocolitis is a serious condition that may require surgery and has a high morbidity and mortality rate. The disease usually affects premature infants, although full-term infants can also develop necrotizing enterocolitis. The disease can also appear in adults when the intestines become infected.
The endothelium inside the intestine contains millions of bacteria. Normally, these bacteria (called the normal microbiome) are harmless and part of the digestive process. However, in necrotizing enterocolitis, bacteria begin to attack the intestinal wall.
If the disease is not treated in time, the intestinal wall will weaken and possibly necrosis. Eventually, a perforation may form in the intestinal wall that spills digestive juices into the abdominal cavity. Intestinal perforation is an emergency requiring immediate surgery and has a high mortality rate.
Necrotizing enterocolitis in children is a serious illness, and about 25% of children who recover from necrotizing enterocolitis will need treatment for long-term problems. Infants who are medically treated for necrotizing enterocolitis may have growth retardation, difficulty absorbing nutrients, and trouble with the liver and gallbladder.
The disease also increases the risk of growth retardation in young children. Infants who have had surgery for necrotizing enterocolitis may also experience long-term complications of the disease. In addition to the effects of treatment, patients with the disease who receive surgery may have serious absorption problems such as short bowel syndrome, are at increased risk for cerebral palsy, and brain and eye problems.

Necrotizing enterocolitis is a serious and complicated disease, so as soon as the disease is detected, it is necessary to transfer the child to a hospital with conditions for timely care, monitoring and treatment. Depending on the severity of the disease, the doctor will prescribe appropriate antibiotic use; replenish water with electrolytes with osezol solution or intravenous infusion of ringer lactate solution; specialized treatment measures such as nasogastric tube placement, anal catheter... In many cases, surgery may be required.
In the early stages, the treatment for necrotizing enterocolitis in children includes stopping milk to let the intestines rest, giving antibiotics to treat the infection, and removing air from the stomach. Your baby will have regular X-rays to monitor the progress of the disease.

If treatment doesn't work or the bowel is perforated, surgery is needed. The doctor will remove any necrotic bowel and other infected parts. The intestines will either be reattached or will be transferred to the abdominal wall through the colostomy. Treatment will continue until the disease is resolved.

Early detection of the disease is very important in shortening the course of treatment and reducing life-threatening complications in children. As soon as the disease is detected, the patient should be immediately transferred to the hospital for timely treatment. The average incubation period is from a few hours to a few days with typical signs such as:
Abdominal pain This is a symptom that is always present in 100% of patients, is the first symptom of the disease, appears on the day the slowest and the slowest to disappear. At first, the patient's pain was intermittent, then the pain was dull; Pain increases when eating or drinking.
The pain is usually localized to the epigastrium or around the navel, or sometimes the location cannot be determined. Pain averages 9 days, in case of necrotizing enterocolitis with shock, the pain is more intense and lasts more than 9 days.
Fever This is also a common symptom in 100% of patients, appearing after abdominal pain but also on the first day of illness. In the case of shock, the fever is usually above 38.5°C.
Blood in the stools Blood in the stools is the most important symptom and is always present in 100% of patients, which is a valuable symptom in the diagnostic decision. This condition appears on the first or second day of illness. The stool is usually red-brown, liquid, with a very special rotten smell.
The amount of stool each time is about 50-200ml. Easy defecation, no straining. In some cases, the patient is unable to defecate on his own, must press firmly on the abdomen or visit the rectum or put a rectal tube to drain the stool.

Vomiting This symptom appears quite early, usually on the 1st and 2nd day of illness. Vomiting usually ceases by day 3 of illness, rarely lasting more than 7 days. If vomiting recurs by week 2, it is usually a complication of intestinal obstruction.
Abdominal distention Abdominal distention appears relatively late compared to the above symptoms, usually on the 3rd day of illness. If abdominal distension occurs early, this is a sign of severe necrotizing enterocolitis.
In addition, some patients may have shock, purple veins on the skin, appearing in the first 2 days of illness. This condition also signals severe necrotizing enterocolitis.
From the above signs, patients can detect early necrotizing enterocolitis, especially in children, for treatment, avoiding dangerous complications to health and life.
With 14 years of experience in the field of Endoscopy - Gastroenterology, Doctor Dong Xuan Ha proficiently performs diagnostic gastrointestinal endoscopy techniques, emergency interventions and therapeutic interventions. Currently, he is a gastroenterologist at the Department of General Internal Medicine, Vinmec Ha Long International General Hospital.