Overview
Definition
A devastating gastrointestinal emergency in premature infants characterized by ischemic necrosis of the intestinal mucosa, mucosal barrier breakdown, and bacterial invasion.
Epidemiology
Occurs in up to 10% of very low birth weight infants (<1500g). Rare in term infants.
Etiology & Risk Factors
- Multifactorial: Intestinal immaturity, mucosal ischemia, enteral formula feeding (breast milk is protective), and abnormal bacterial colonization
Clinical Symptoms
- Feeding intolerance (increased gastric residuals)
- Abdominal distention and tenderness
- Gross or occult blood in stool
- Systemic signs: Temperature instability, apnea, bradycardia, lethargy, septic shock
Clinical Approach
Diagnosis
- Abdominal X-Ray showing pneumatosis intestinalis (gas in the bowel wall - diagnostic) or portal venous gas; free air (pneumoperitoneum) indicates perforation
Management
- NPO immediately and gastric decompression (NG tube)
- Broad-spectrum IV antibiotics
- Aggressive fluid resuscitation and cardiovascular support
- Surgical laparotomy with bowel resection and ostomy placement for perforation or clinical deterioration
Complications
- Short Bowel Syndrome (due to extensive resection)
- Intestinal strictures
- Sepsis / Mortality (up to 20-30%)