NECROTIZING ENTEROCOLITIS - SYMPTOMATOLOGY, DIAGNOSIS AND THERAPEUTIC CONSEQUENCES

Within a 6-year period ten patients with necrotizing enterocolitis (grade II-III; Bell) have been treated at the University Hospital, Gottingen. The following NEC incidences were calculated: birth weight < 1000 g: 2.4 % (3/123); 1000-1 500 g: 0.6 % (2/308); 1501-2000 g: 0.7 % (3/436); > 3000 g: approximately 0.006 % (2/30000 live births). In all patients onset of necrotizing enterocolitis (NEC) was associated with typical clinical symptoms such as abdominal distension, feeding problems, bloody stools. Only four out of ten patients had positive blood tests of various inflammatory parameters when diagnosed (C-reactive protein, neutrophil count, I/T-ratio). However, increased CRP levels were observed in all patients during the course of the disease (maximum levels: day 2-4 after diagnosis). During primarily conservative therapeutic management only one out of ten patients developed bowel perforation (day 6 after diagnosis) and immediate surgical treatment was carried out. In addition, in three patients who acquired strictures with obstruction of the colon, elective surgery was performed at a postnatal age of 51-77 days. All patients survived NEC without long-term sequelae. We conclude that a primarily conservative therapeutic regimen - whenever perforation and gangrene are absent - may be an alternative to early surgical intervention in NEC.