Zusammenfassung
Die nekrotisierende Enterokolitis (NEC) ist die häufigste lebensbedrohliche, gastrointestinale Störung in der Neonatalperiode. Es sind fast immer Früh- und Neugeborene auf der Intensivstation (NICU) betroffen. Die meisten Fälle sind sporadisch, ein epidemisches Auftreten ist jedoch in Assoziation mit aeroben und anaeroben Bakterien sowie Viren beschrieben. Mit wenigen Ausnahmen tritt die NEC meist ab der zweiten Lebenswoche auf und häufig nach dem Beginn enteraler Nahrung. Die Diagnose basiert auf charakteristischen klinischen, laborchemischen sowie radiologischen Zeichen. Therapeutisch ist die orale/enterale Ernährung zu beenden; per Magensonde lässt sich der meist galliger Mageninhalt absaugen. Eine Antibiotikatherapie ist angezeigt. Probiotika und Inhibitoren inflammatorischer Signalwege wurden untersucht. Etwa die Hälfte der Kinder mit NEC benötigt eine Operation, meist wegen einer Darmperforation mit Pneumoperitoneum oder der Notwendigkeit, nekrotisches Darmgewebe zu entfernen. Je reifer das Kind bei Geburt ist, desto besser ist die Prognose.
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Literatur
Amin HJ, Zamora SA, McMillan DD, Fick GH, Butzner J, Decker, Parsons HG, Scott RB (2002) Arginine supplementation prevents necrotizing enterocolitis in the premature infant. J Pediatr 140(4):425–431. https://doi.org/10.1067/mpd.2002.123289
Bain J, Benjamin DK, Hornik CP, Clark R, Smith PB (2014) Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects. J Perinatol 34(4):319–321. https://doi.org/10.1038/jp.2013.174
Bell MJ (1978) Neonatal necrotizing enterocolitis. N Engl J Med 298(5):281–282
Berman L, Moss RL (2011) Necrotizing enterocolitis. An update. Seminars in fetal & neonatal medicine 16(3):145–150. https://doi.org/10.1016/j.siny.2011.02.002
Chan K, Ohlsson A, Synnes A, Lee DS, Chien LY, Lee SK (2001) Survival, morbidity, and resource use of infants of 25 weeks’ gestational age or less. Am J Obstet Gynecol 185(1):220–226. https://doi.org/10.1067/mob.2001.115280
Chan KYY, Leung KT, Tam YH, Lam HS, Cheung HM, Ma TPY et al (2014) Genome-wide expression profiles of necrotizing enterocolitis versus spontaneous intestinal perforation in human intestinal tissues. Dysregulation of functional pathways. Ann Surg 260(6):1128–1137. https://doi.org/10.1097/SLA.0000000000000374
Costeloe K, Hardy P, Juszczak E, Wilks M, Millar MR (2016) Bifidobacterium breve BBG-001 in very preterm infants. A randomised controlled phase 3 trial. Lancet (London, England) 387(10019):649–660. https://doi.org/10.1016/S0140-6736(15)01027-2
Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sánchez PJ et al (2009) Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 123(1):58–66. https://doi.org/10.1542/peds.2007-3423
Eibl MM, Wolf HM, Fürnkranz H, Rosenkranz A (1988) Prevention of necrotizing enterocolitis in low-birth-weight infants by IgA-IgG feeding. N Engl J Med 319(1):1–7. https://doi.org/10.1056/NEJM198807073190101
Ein SH, Marshall DG, Girvan D (1977) Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. J Pediatr Surg 12(6):963–967
Elimian A, Garry D, Figueroa R, Spitzer A, Wiencek V, Quirk JG (2007) Antenatal betamethasone compared with dexamethasone (betacode trial). A randomized controlled trial. Obstet Gynecol 110(1):26–30. https://doi.org/10.1097/01.AOG.0000268281.36788.81
Fisher JG, Jones BA, Gutierrez IM, Hull MA, Kang KH, Kenny M, Zurakowski D, Modi BP, Horbar JD, Jaksic T (2014) Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: a prospective 5-year multicenter analysis. J Pediatr Surg 49(8):1215–1219
Foster JP, Seth R, Cole MJ (2016) Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates. Cochrane Database Syst Rev (4):CD001816. https://doi.org/10.1002/14651858.CD001816.pub3
Frey EE, Smith W, Franken EA, Wintermeyer KA (1987) Analysis of bowel perforation in necrotizing enterocolitis. Pediatr Radiol 17(5):380–382
Garbi-Goutel A, Brévaut-Malaty V, Panuel M, Michel F, Merrot T, Gire C (2014) Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. J Pediatr Surg 49(4):508–513. https://doi.org/10.1016/j.jpedsurg.2013.11.057
Gause CD, Hayashi M, Haney C, Rhee D, Karim O, Weir BW et al (2016) Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates. J Pediatr Surg 51(11):1759–1765. https://doi.org/10.1016/j.jpedsurg.2016.06.018
Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM (2014) Discrimination of GutCheck(NEC). A clinical risk index for necrotizing enterocolitis. J Perinatol 34(6):468–475. https://doi.org/10.1038/jp.2014.37
Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE (2008) Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 82(7–8):341–347. https://doi.org/10.1016/j.lfs.2007.09.036
Ginzel M, Yu Y, Klemann C, Feng X, von Wasielewski R, Park J-K et al (2016) The viral dsRNA analogue poly (I:C) induces necrotizing enterocolitis in neonatal mice. Pediatr Res 79(4):596–602. https://doi.org/10.1038/pr.2015.261
Ginzel M, Feng X, Kuebler JF, Klemann C, Yu Y, von Wasielewski R et al (2017) Dextran sodium sulfate (DSS) induces necrotizing enterocolitis-like lesions in neonatal mice. PloS one 12(8):e0182732. https://doi.org/10.1371/journal.pone.0182732
Gordon PV (2009) Understanding intestinal vulnerability to perforation in the extremely low birth weight infant. Pediatr Res 65(2):138–144. https://doi.org/10.1203/PDR.0b013e31818c7920
Gordon PV, Swanson JR, MacQueen BC, Christensen RD (2017) A critical question for NEC researchers: can we create a consensus definition of NEC that facilitates research progress? Semin Perinatol 41(1):7–14
Guillet R, Stoll BJ, Cotten CM, Gantz M, McDonald S, Poole WK, Phelps DL (2006) Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 117(2):e137–e142. https://doi.org/10.1542/peds.2005-1543
Guinn DA, Atkinson MW, Sullivan L, Lee M, MacGregor S, Parilla BV et al (2001) Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery. A randomized controlled trial. JAMA 286(13):1581–1587
Gutierrez IM, Kang KH, Jaksic T (2011) Neonatal short bowel syndrome. Semin Fetal Neonatal Med 16(3):157–163. https://doi.org/10.1016/j.siny.2011.02.001
Hajivassiliou CA, Pitkin J (1998) Recurrent necrotizing enterocolitis associated with episodes of supraventricular tachycardia. J Pediatr Surg 33(10):1569–1570
Hall NJ, Peters M, Eaton S, Pierro A (2004) Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg 39(6):898–901; discussion 898–901
Haricharan RN, Gallimore JP, Nasr A (2017) Primary anastomosis or ostomy in necrotizing enterocolitis? Pediatr Surg Int 33(11):1139–1145. https://doi.org/10.1007/s00383-017-4126-z
Heida FH, Loos MHJ, Stolwijk L, Te Kiefte BJC, van den Ende SJ, Onland W et al (2016) Risk factors associated with postnecrotizing enterocolitis strictures in infants. J Pediatr Surg 51(7):1126–1130. https://doi.org/10.1016/j.jpedsurg.2015.09.015
Heida FH, Stolwijk L, Loos M-LHJ, van den Ende SJ, Onland W, van den Dungen FAM et al (2017) Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants. Results from three academic referral centers. J Pediatr Surg 52(2):273–276. https://doi.org/10.1016/j.jpedsurg.2016.11.024
Hodzic Z, Bolock AM, Good M (2017) The role of mucosal immunity in the pathogenesis of necrotizing enterocolitis. Front Pediatr 5:40. https://doi.org/10.3389/fped.2017.00040
Hull MA, Fisher JG, Gutierrez IM, Jones BA, Kang KH, Kenny M, Zurakowski D, Modi BP, Horbar JD, Jaksic T (2014) Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg 218(6):1148–1155
Karpelowsky JS, van Mil S, Numanoglu A, Leva E, Millar AJW (2010) Effect of maternal human immunodeficiency virus status on the outcome of neonates with necrotizing enterocolitis. J Pediatr Surg 45(2):315–318; discussion 318. https://doi.org/10.1016/j.jpedsurg.2009.10.068
Kosloske AM (1994) Indications for operation in necrotizing enterocolitis revisited. J Pediatr Surg 29(5):663–666
Lawrence G, Tudehope D, Baumann K, Jeffery H, Gill A, Cole M et al (2001) Enteral human IgG for prevention of necrotising enterocolitis. A placebo-controlled, randomised trial. Lancet (London, England) 357(9274):2090–2094. https://doi.org/10.1016/S0140-6736(00)05182-5
Leaphart CL, Cavallo J, Gribar SC, Cetin S, Li J, Branca MF et al (2007) A critical role for TLR4 in the pathogenesis of necrotizing enterocolitis by modulating intestinal injury and repair. J Immunol (Baltimore, Md.: 1950) 179(7):4808–4820
Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F (2013) Nosocomial infections in very low birthweight infants in Germany. Current data from the National Surveillance System NEO-KISS. Klin Padiatr 225(2):75–80. https://doi.org/10.1055/s-0033-1334886
Lemyre B, Xiu W, Bouali NR, Brintnell J, Janigan J-A, Suh KN, Barrowman N (2012) A decrease in the number of cases of necrotizing enterocolitis associated with the enhancement of infection prevention and control measures during a Staphylococcus aureus outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol 33(1):29–33. https://doi.org/10.1086/663343
Maheshwari A (2015) Immunologic and hematological abnormalities in necrotizing enterocolitis. Clin Perinatol 42(3):567–585. https://doi.org/10.1016/j.clp.2015.04.014
Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF (2009) Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol 29(1):57–62. https://doi.org/10.1038/jp.2008.117
Molik KA, West KW, Rescorla FJ, Scherer LR, Engum SA, Grosfeld JL (2001) Portal venous air. The poor prognosis persists. J Pediatr Surg 36(8):1143–1145. https://doi.org/10.1053/jpsu.2001.25732
Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM et al (2006) Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 354(21):2225–2234. https://doi.org/10.1056/NEJMoa054605
Muller A, Schurink M, Bos AF, Hulzebos CV, Martijn A, Hulscher JBF, Kooi EMW (2014) Clinical importance of a fixed bowel loop in the treatment of necrotizing enterocolitis. Neonatology 105(1):33–38. https://doi.org/10.1159/000355064
Musemeche CA, Kosloske AM, Bartow SA, Umland ET (1986) Comparative effects of ischemia, bacteria, and substrate on the pathogenesis of intestinal necrosis. J Pediatr Surg 21(6):536–538
Neu J (2014) Necrotizing enterocolitis. The mystery goes on. Neonatology 106(4):289–295. https://doi.org/10.1159/000365130
O’Connor A, Sawin RS (1998) High morbidity of enterostomy and its closure in premature infants with necrotizing enterocolitis. Arch Surg (Chicago, Ill: 1960) 133(8):875–880
Oddie SJ, Young L, McGuire W (2017) Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev (8):CD001241. https://doi.org/10.1002/14651858.CD001241.pub7
Ostlie DJ, Spilde TL, Peter S, Shawn D, Sexton N, Miller KA, Sharp RJ et al (2003) Necrotizing enterocolitis in full-term infants. J Pediatr Surg 38(7):1039–1042
Palmer C, Bik EM, DiGiulio DB, Relman DA, Brown PO (2007) Development of the human infant intestinal microbiota. PLoS Biol 5(7):e177. https://doi.org/10.1371/journal.pbio.0050177
Pammi M, Cope J, Tarr PI, Warner BB, Morrow AL, Mai V et al (2017) Intestinal dysbiosis in preterm infants preceding necrotizing enterocolitis. A systematic review and meta-analysis. Microbiome 5(1):31. https://doi.org/10.1186/s40168-017-0248-8
Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR et al (2015) Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 372(4):331–340. https://doi.org/10.1056/NEJMoa1403489
Potoka DA, Upperman JS, Zhang X-R, Kaplan JR, Corey SJ, Grishin A et al (2003) Peroxynitrite inhibits enterocyte proliferation and modulates Src kinase activity in vitro. Am J Physiol Gastrointest Liver Physiol 285(5):G861–G869. https://doi.org/10.1152/ajpgi.00412.2002
Quigley MA, Henderson G, Anthony MY, McGuire W (2007) Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev (4):CD002971. https://doi.org/10.1002/14651858.CD002971.pub2
Rao SC, Athalye-Jape GK, Deshpande GC, Simmer KN, Patole SK (2016) Probiotic supplementation and late-onset sepsis in preterm infants. A meta-analysis. Pediatrics 137(3):e20153684. https://doi.org/10.1542/peds.2015-3684
Reber KM, Nankervis CA (2004) Necrotizing enterocolitis. Preventative strategies. Clin Perinatol 31(1):157–167. https://doi.org/10.1016/j.clp.2004.03.002
Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A (2008) Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg 248(1):44–51. https://doi.org/10.1097/SLA.0b013e318176bf81
Remon JI, Amin SC, Mehendale SR, Rao R, Luciano AA, Garzon SA, Maheshwari A (2015) Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical necrotizing enterocolitis. J Perinatol 35(9):755–762. https://doi.org/10.1038/jp.2015.51
Roberts D, Dalziel S (2006) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev (3):CD004454. https://doi.org/10.1002/14651858.CD004454.pub2
Romagnoli C, Frezza S, Cingolani A, de Luca A, Puopolo M, de Carolis MP et al (2001) Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 160(6):345–350
Scheifele DW, Melton PW, Ebelt V (1981) Endotoxinaemia per se as cause of neonatal morbidity. Lancet (London, England) 1(8215):337
Sharma R, Tepas JJ, Hudak ML, Wludyka PS, Mollitt DL, Garrison RD et al (2005) Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis. J Pediatr Surg 40(2):371–376. https://doi.org/10.1016/j.jpedsurg.2004.10.022
Siu YK, Ng PC, Fung SC, Lee CH, Wong MY, Fok TF et al (1998) Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 79(2):F105–F109
Smith B, Bodé S, Petersen BL, Jensen TK, Pipper C, Kloppenborg J et al (2011) Community analysis of bacteria colonizing intestinal tissue of neonates with necrotizing enterocolitis. BMC Microbiol 11:73. https://doi.org/10.1186/1471-2180-11-73
Snyder CL, Gittes GK, Murphy JP, Sharp RJ, Ashcraft KW, Amoury RA (1997) Survival after necrotizing enterocolitis in infants weighing less than 1,000 g. 25 years’ experience at a single institution. J Pediatr Surg 32(3):434–437
Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M (2000) Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis. Acta paediatrica (Oslo, Norway: 1992) 89(5):528–532
Stoll BJ (1994) Epidemiology of necrotizing enterocolitis. Clin Perinatol 21(2):205–218
Stringer MD, Brereton RJ, Drake DP, Kiely EM, Capps SN, Spitz L (1993) Recurrent necrotizing enterocolitis. J Pediatr Surg 28(8):979–981
Sullivan PB, Lewindon PJ, Cheng C, Lenehan PF, Kuo B-S, Haskins JR et al (2007) Intestinal mucosa remodeling by recombinant human epidermal growth factor(1–48) in neonates with severe necrotizing enterocolitis. J Pediatr Surg 42(3):462–469. https://doi.org/10.1016/j.jpedsurg.2006.10.039
Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawöger R, Kiechl-Kohlendorfer U et al (2010) An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr 156(4):562–567.e1. https://doi.org/10.1016/j.jpeds.2009.10.040
Sun J, Marwah G, Westgarth M, Buys N, Ellwood D, Gray PH (2017) Effects of probiotics on necrotizing enterocolitis, sepsis, intraventricular hemorrhage, mortality, length of hospital stay, and weight gain in very preterm infants. A meta-analysis. Advances in nutrition (Bethesda, Md) 8(5):749–763. https://doi.org/10.3945/an.116.014605
Sylvester KG, Moss RL (2015) Urine biomarkers for necrotizing enterocolitis. Pediatr Surg Int 31(5):421–429. https://doi.org/10.1007/s00383-015-3693-0
Tam AL, Camberos A, Applebaum H (2002) Surgical decision making in necrotizing enterocolitis and focal intestinal perforation. Predictive value of radiologic findings. J Pediatr Surg 37(12):1688–1691. https://doi.org/10.1053/jpsu.2002.36696
VanderKolk WE, Kurz P, Daniels J, Warner BW (1996) Liver hemorrhage during laparotomy in patients with necrotizing enterocolitis. J Pediatr Surg 31(8):1063–1066; discussion 1066–1067
Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ et al (2000) Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics 105(6):1216–1226
Vongbhavit K, Underwood MA (2016) Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant. Clin Ther 38(4):716–732. https://doi.org/10.1016/j.clinthera.2016.01.006
Wessel JJ, Kocoshis SA (2007) Nutritional management of infants with short bowel syndrome. Semin Perinatol 31(2):104–111. https://doi.org/10.1053/j.semperi.2007.02.009
Wilson-Costello D, Rao PS, Morrison S, Hack M (1996) Radiation exposure from diagnostic radiographs in extremely low birth weight infants. Pediatrics 97(3):369–374
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Lacher, M. (2018). Nekrotisierende Enterokolitis. In: von Schweinitz, D., Ure, B. (eds) Kinderchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53390-1_49-1
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