Topics Discussed: enterocolitis, necrotizing; gastroenterology
and hepatology; gastrointestinal perforation; intestinal
perforation. Excerpt:"Definition. Necrotizing enterocolitis
(NEC) is an ischemic and inflammatory necrosis of the bowel
primarily affecting premature neonates after the initiation of
enteral feeding. Incidence. NEC is predominantly a disorder of
preterm infants, with an incidence of 610% in infants weighing
<1500g. Although 10% of all cases of NEC occur in term infants,
the incidence is highest in premature infants. NEC has an
overall mortality of 1030%. Pathophysiology. A multifactorial
theory has been suggested in which several risk factors
including prematurity, formula feedings, ischemia, and bacterial
colonization interact to initiate mucosal damage via a final
common pathway involving activation of the inflammatory cascade.
Mucosal damage results in an invasion of the bowel wall by gas
producing bacteria, resulting in an intramural gas accumulation
(pneumatosis intestinalis). This sequ