Necrotizing Enterocolitis
Joel K. Greenson, MD
Key Facts
Etiology/Pathogenesis
Hyperosmolar feedings increase risk of disease
Bacterial colonization also seems to play a role
Clinical Issues
Death secondary to sepsis from bowel perforation
Overall mortality 20-40%
Incidence increasing as more low birth-weight premature infants survive
Microscopic Pathology
Ischemic damage with coagulative necrosis of mucosa and bowel wall
May mimic quiescent inflammatory bowel disease
Chronic changes develop later with strictures and crypt distortion
Few inflammatory cells in lamina propria, appropriate for age
 Hematoxylin & eosin shows a low-power view of a necrotic small bowel. The entire mucosa surface shows coagulative necrosis  . |
 Hematoxylin & eosin shows a higher power view of small bowel mucosa with coagulative necrosis. The histopathologic changes of NEC are largely those of ischemia. |
TERMINOLOGY
Abbreviations
Necrotizing enterocolitis (NEC)
Definitions
Idiopathic enterocolitis typified by coagulative/hemorrhagic necrosis and inflammation of small bowel and proximal colon
Most often seen in premature infants
ETIOLOGY/PATHOGENESIS
Uncertain Etiology
Related to combination of immature gut and decreased blood flow leading to ischemia
Hyperosmolar feedings increase risk of disease
Bacterial colonization also seems to play a role
CLINICAL ISSUES
Epidemiology
Incidence
Between 1-2.4 per 1,000 live births in USA
Incidence increasing as more low birth-weight premature infants survive
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