Necrotizing Enterocolitis in the First 24 Hours of Life

[摘要] Necrotizing enterocolitis (NEC) is commonly thought of as occuring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 ± 849 g), more mature (mean gestational age 37.9 ± 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 ± 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 ± 586 g, mean gestational age 32.0 ± 3.5 weeks, P < .001, and mean five-minute Apgar score 6.81 ± 1.84, P < .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.

[学科分类] 儿科学