There appears to be a bimodal distribution (early versus late onset) based on GA. For example, the median age at onset of NEC in infants with a GA of less than 26 weeks was 23 days (late), and for those with a GA of greater than 31 weeks, the median age at onset was 11 days (early). Laboratory findings of infants presenting with NEC often include anemia, thrombocytopenia, evidence of disseminated intravascular coagulopathy (DIC), and in 20 percent of cases a positive blood culture. Signs and symptoms
CNE is a necrotizing inflammation of the small bowel (especially the jejunum but also the ileum). Clinical results may vary from mild diarrhea to a life-threatening sequence of severe abdominal pain, vomiting (often bloody), bloody stool, ulceration of the small intestine with leakage (perforation) into the peritoneal cavity and possible death within a single day due to peritonitis. Many patients exhibit meteorism (swelling of the abdomen due to excess gas) and fever. Fluid can enter the peritoneum. Sepsis can occur, with one case having 28,500 white blood cells per cubic milliliter. Causes
All the factors collectively causing CNE are generally only present in the hinterlands of New Guinea and parts of Africa, Latin America, and Asia. These factors include protein deprivation (causing inadequate synthesis of the enzyme trypsin protease, to which the toxin is very sensitive), poor food hygiene, episodic meat feasting, staple diets containing trypsin inhibitors (sweet potatoes), and infection by Ascaris parasites, which secrete a trypsin inhibitor.
Acceptable empiric regimens include, but are not limited to, the following . :
•Ampicillin plus gentamicin (or amikacin) plus metronidazole
•Ampicillin plus gentamicin (or amikacin) plus clindamycin
•Ampicillin plus an expanded-spectrum cephalosporin (eg, cefotaxime [where available], ceftazidime, or cefepime) plus metronidazole
•Monotherapy with piperacillin-tazobactam
•Monotherapy with meropenem
Vancomycin should be included in the regimen (ie, replacing ampicillin or added to monotherapy) in centers where there is a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) or ampicillin-resistant enterococcal infections. Centers with significant gentamicin resistance patterns should consider amikacin in place of gentamicin. We do not recommend the use of oral aminoglycosides because this treatment can result in the development of resistant bacterial strains, and has not been shown to be more beneficial than standard care. Other clostridial toxemias
Leukemia patients, cancer chemotherapy recipients and others suffering from suppressed white blood cells (neutropenia) can be afflicted by a similar syndrome, neutropenic enterocolitis, in which the cecum is targeted by Clostridium septicum in much the same way. In neonatal intensive-care units, the syndrome of neonatal necrotizing enterocolitis may be caused in a similar way by C. perfringens, C. butyricum, and C. difficile, but this has not been proved. See also
Protein poisoning refers to a different diet-induced phenomenon. References


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