define NECROTIZING ENTEROCOLOITIS (NEC)
acute inflammatory process from ischemic necrosis of mucosal lining of either/both intestines when intestinal tract of preemie becomes active
s/s: necrotizing enterocolitis
feeding intolerance, abdominal distention, diarrhea, bile-colored emesis, blood in stool, decreased/absent bowel sounds, lethargy, body temp instability, brief apneic periods, reduced urine output, hyperbilirubinemia, erythema, tender abdomen
cause: necrotizing enterocolitis
unknown: theory = normal GI flora invade intestinal mucosa from shunted blood flow to GI; hypovolemia, sepsis, umbilical catheters, exchange transfusions, IRDS, oral high-calorie concentrated formula
how to diagnosis for necrotizing enterocolitis
- observe feeding and activity level, abdominal distention, impaired body temp, breathing difficulty
- CBC shows elevated WBC
- Guaiac test positive for occult blood
- blood & stool cultures positive for bacteria
- radiology of intestine
tx: necrotizing entercolitis
NPO, feedings via NG/oral tube, IV fluids & antibiotics, monitor respirations & pH, monitor abdominal distention, monitor weigh/input/ouput
prognosis of necrotizing entercolitis
fatal w/o immediate & aggressive intervention
how to prevent necrotizing entercolitis
hand washing & breast milk
aka: congenital hypertrophic pyloric stenosis
congenital pyloric stenosis
define CONGENITAL PYLORIC STENOSIS
obstruction associated w/narrowing of pyloric sphincter at exit of stomach
sx: congenital pyloric stenosis
- projectile vomiting
- failure to gain weight
- baby appears hungry, feeds, but doesn’t gain weight
- dehydration & electrolyte imbalances
- olive-shaped hard mass
- left to right peristalsis & reverse peristalsis
- no bile in emesis
cause: congenital pyloric stenosis
unknown; hereditary
congenital pyloric stenosis occurs more in
males
how is congenital pyloric stenosis diagnosed
upper GI radiographic study & ultrasound
tx: congenital pyloric stenosis
pyloromyotomy
aka: Hirschsprung disease
congenital aganglionic megacolon
define HIRSCHSPRUNG DISEASE
impairment of intestinal motility causing obstruction of distal colon
sx: hirschsprung disease
- newborn doesn’t pass meconium within 48 hours
- bile-stained/fecal vomitus
- doesn’t want to feed
- distended abdomen
- failure to thrive
- obstinate constipation
- vomiting
- fever
- explosive watery diarrhea
- ribbon-like foul smelling stools
- easily palpable fecal masses
- visible peristalsis
- malnourishment & anemia
cause: Hirschsprung disease
absence of parasympathetic nerve ganglion cells in segment of colon
Hirschsprung disease is more common in
males and people with down syndrome
how is Hirschsprung disease diagnosed
family history, clinical picture, xray of bowels, biopsy
tx: Hirschsprung disease
- surgery
- temporary colostomy
- maintain electrolyte and fluid balance
define INFANTILE COLIC
intermittent distress in newborn
cause of infantile colic
unknown
