Clinical and laboratory study of Necrotizing Enterocolitis in Maharashtra population

 

Jaywant Deore

 

Abstract               Background: NEC is the major gastro intestinal emergency in LBW and VLBW in premature babies in which necrosis of ilio-ceacal junction often observed during feeding reduction which require surgical correction Method: Out of 1016 neonates 34(3.3% were diagnosed as NEC. Antenatal and peri-natal feeding history was noted. Blood examination including CBC, CRP, ABG SGPT and coagulation profile. BUN and Sr.cretanine. Stool routine and microscopic, x-ray, USG abdomen was to rule out the severity of NEC. Results: 2(5.9%) were > 2.5 kg weight 15(44%) were LBW 1.5 to 2.5 kg, 17(50%) <1.5kg. the gestational age of 28(82.4%) was between 28-32 weeks 3(8.8%) were between 32-36 week 3(8.8%) were >36 weeks. Laboratory finding were 25(73.5%) had thrombocytopenia 23(67.6%) had raised CRP 18(52.9%) had reduced s.Na⁺. 14(41.2%) had acidosis 2(5.8%) had deranged coagulations profile 24 (70.6%) had occult blood in stool. The organism were 1(2.9%) Candida 3(8.8%) E.coli 3(8.8%) P Aeurginosa, 8(23.5%) staph-Aureus 17(50%) were sterile, X-ray reported had 8(23.5%) had mild Ileus, 8(23.5%) Had intestinal dilation 1(2.9%) had minimal abdominal fluid, 8(23.5%) pnematosis, 16 (47%) had normal x-ray. The Associated clinical manifestation were 16(47.6%) had sepsis (EONS, LONS), 23(67.6%) had respiratory distress syndrome, 8(23.5%) had Apnea of prematurity. Conclusion: The evaluation of present study NEC will be certainly helpful to pediatrician or neonatal surgeon to treat such NEC patients efficiently and prevent morbidity and mortality of infants.

Keywords: -NEC= Necrotizing Enterocolitis, DAMA= Discharges against medical advice, Acidosis, NICU=Neonatal Intensive care, ECONS= Early onset Neonatal sepsis

 

INTRODUCTION

Necrotizing Enter colitis (NEC) is common gastro intestinal emergency that mainly affects very low birth weight, preterm infants neonatal in the. NEC occurs in the distal ileum and proximal colon, characterized by inflammatory necrosis^1,2. The pathogenesis of NEC is complex, multi factorial and idiopathic³. In spite of latest technologies broad spectrum antibiotics over last decades the morbidity and mortalities remain high in NEC in India and abroad too. LBW (Low birth weight) and prematurity neonates are major factors in NEC^4,5, Which leads to, improper functional development of GIT. Diagnostic value NET depends on clinical symptoms correlated with laboratory investigations and radiological and ultimate surgical intervention is the last resort. Hence attempt was made to evaluate various clinical manifestation, laboratory and radiological findings so that. It may be helpful for early diagnosis and prevent morbidity and mortality of neonates.

                 

MATERIAL AND METHODS

1016 Neonates admitted at Chirantan Arogyaseva and Sanshodhan Sansthan Deopur Dhule- Maharashtra.

Inclusion criteria: Out of 1016 neonates 34 neonates having the symptoms of NEC i.e.- Abdominal distention, delayed gastric emptying, reduced or absence of peristalsis increased RT aspirate, GI bleeding- lethargic and hypothermic babies.

Exclusion criteria: Any surgical G I obstruction death within 24 hours of admission, patients undergone DAMA

Methods: Antenatal, peri natal and feeding history of 34 Neonates was recorded GIT, CNS, CVS were studied meticulously. Blood examination included CBC, CRP, ABG, SGPT and coagulation profile BUN and Sr. cretanine stool routine and microscopic, x- ray erect and supine USG abdomens was carried out to study the severity of NEC. Duration of study was from 2011 to 2013.

Statistical analysis- Various clinical manifestations, findings were classified with percentage. The statistical analysis was done at SPSS 2007 soft ware

 

OBSERVATION AND RESULTS

Table-1 – Birth weight of the Neonates with NEC was 2(5.9%) were > 2.5 kg weight 15(44%) were LBW (1.5 to 2.5 kg) 17 (50%) VLBW.

Table-2- The gestational age of neonates with NEC was 28(82.4%) was between 28-32 weeks, 3(8.8%) were between 32-36 week 3(8.8%) were >36 weeks.

Table-3- Laboratory finding were 25(73.5%) had thrombocytopenia 23(67.6%) had raised CRP 18(52.9%) had reduced Serum. Na⁺. 14(41.2%) had acidosis 2(5.8%) had deranged coagulations profile, 24 (70.6%) had positive occult blood in stool.

Table-4- Study of Blood and stool culture in Neonates with NEC, In the blood culture 1(2.9%)had Candida 3(8.8%) E.coli, 3(8.8%) Pseudomas Aeurginosa, 8(23.5%) staph-Aureus 17(50%) were sterile

Table-5- Study of X-ray in Neonates with NEC 8(23.5%) had mild Ileus, 8(23.5%) Had intestinal dilation 1(2.9%) had minimal abdominal fluid 8(23.5%) had intestinal dilation.

The associated clinical manifestation were 16(47.6%) had sepsis (EONS, LONS), 23(67.6%) had respiratory distress syndrome, 8(23.5%) had Apnea of prematurity.

Table 1: (No of patients 34)Birth weight of Neonates with NEC

LBW= Low Birth Weight, VLBW= very low birth weight

 

Table 2:(No of patients 34)Gestational age of neonates with NEC

 

Table 3: (No of patients 34) Laboratory finding of neonates with NEC

CRP- C-reative protein, ABG= Arterial Blood Gas

 

Table 4: (No of patients 34) Blood and stool culture of Neonates with NEC

 

Table 5: (No of patients 34) Study of X-ray in Neonates with NEC

 

Table 6: (No of patients 34) Associated clinical manifestations in neonates with NEC

DISCUSSION

In the present study of NEC in Neonates of Maharashtra population- Out of 1016 neonates 34 (3.3%) were selected as NEC, having birth weight was 2 (5.9%) were more than (> 2.5) kg, 15(44%) were LBW (1.5 to 2.5 kg) 17 (50%)VLBW.(Table-1). The gestational age of neonates with NEC was 28(82.4%) was between 28-32 weeks, 3(8.8%) were between 32-36 week 3(8.8%) were >36 weeks.(Table-2). Laboratory findings were 25(73.5%) had thrombocytopenia, 23(67.6%) had raised CRP 18(52.9%) had reduced Serum. Na⁺. 14(41.2%) had acidosis 2(5.8%) had deranged coagulations profile 24 (70.6%) had positive occult blood in stool.(Table-3). The Blood and stool culture in Neonates with NEC. In the blood culture 1(2.9%)had Candida 3(8.8%) E.coli, 3(8.8%) Pseudomas Aeurginosa, 8(23.5%) staph-Aureus 17(50%) were sterile. (Table-4). The radiology study had 8(23.5%) had mild Ileus, 8(23.5%) Had intestinal dilation 1(2.9%) had minimal abdominal fluid 8(23.5%) pnematosis, 16 (47%) had normal x-ray. The Associated clinical manifestation were 16(47.6%) had sepsis (EONS, LONS) 23(67.6%) had respiratory distress syndrome 8(23.5%) had Apnea of prematurity (Table-6). These findings were more or less agreement with previous studies^6,7,8.  As the prevalence of NET is idiopathic. Hence it can be hypothesized that LBW, small gestational age could be the core factors results into NEC⁹. Moreover NEC was noted approximately 90% of infants after being fed, where as hardly 10% or less before feeding was noted¹⁰. Again this confirms that there was ischemia or necrosis where feeding was not accepted by ilio-ceacal junction. Moreover reduction in feeding day by day¹¹. gives a though that there might be improper rotation of gut in anti clock wise direction hence there might be development of NEC. In addition to this LBW or VLBW neonates could be due to un-favorable atmosphere in the intra-uterine or fetal life (IUL) due mal-nutrition or under nourished pregnant mother. Hence the LBW or VLBW would have been prone to many pathogenesis including NEC. It is established fact that, majority of Indian women is suffering with obsessive compulsive Disorder (OCD). Hence though such women are well fed during pregnancy there will be variations in the release of hormones, neuro transmitters which would affect the fetus, might lead to NEC. In addition to this illiteracy and poverty will keep pregnant mothers from proper and regular medical checkup can be the contributory factors for development of NEC.

SUMMARY AND CONCLUSION

The present study had 3.3% percentage of NEC observed in both sexes. Abnormal maternal antenatal history had a major role in NEC, because formation of germ layers at stipulated period, require proper nutrition, medication so that, there will be complete development of fetus. But this study further demands genetic, embryological, nutritional, hormonal, neurological study because exact cause of NEC is still un-clear. This research paper was approved by Ethical Committee of SBHG MC Dhule-424001, Maharashtra

 

REFERENCES

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