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Necrotizing Enterocolitis
Hank Baskin, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Necrotizing enterocolitis (NEC): Poorly understood but life-threatening condition of neonatal GI tract characterized by inflammation, ischemia, & translocation of bacteria into bowel wall
          • Very low birth weight (VLBW) infant: < 1,500 g
          • Extremely low birth weight (ELBW) infant: < 1,000 g

        IMAGING

        • General Features

          • Radiographic Findings

            • Ultrasonographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Baskin H. Practical Pediatric Imaging: Practical imaging. https://itun.es/us/JnCQM.l Reviewed March 30, 2016. Accessed March 30, 2016
                                        2. He Y et al: Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 105(4):e151-5, 2016
                                        3. Lau CS et al: Probiotic administration can prevent necrotizing enterocolitis in preterm infants: A meta-analysis. J Pediatr Surg. 50(8):1405-12, 2015
                                        4. Zani A et al: Necrotizing enterocolitis: controversies and challenges. F1000Res. 4, 2015
                                        5. Markel TA et al: Predicting disease severity of necrotizing enterocolitis: how to identify infants for future novel therapies. J Clin Neonatol. 3(1):1-9, 2014
                                        6. Yikilmaz A et al: Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatr Surg Int. 30(12):1231-40, 2014
                                        7. Muchantef K et al: Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 43(11):1444-52, 2013
                                        8. Sharma R et al: A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol. 40(1):27-51, 2013
                                        9. Silva CT et al: A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit. Pediatr Radiol. 43(11):1453-63, 2013
                                        10. Yee WH et al: Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 129(2):e298-304, 2012
                                        11. Hollingsworth CL et al: The Duke Abdominal Assessment Scale: initial experience. Expert Rev Gastroenterol Hepatol. 4(5):569-74, 2010
                                        12. Ryan S et al: Gastrointestinal pathology in neonates: new imaging strategies. Pediatr Radiol. 40(6):927-31, 2010
                                        13. Coursey CA et al: Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis. AJR Am J Roentgenol. 193(5):1408-13, 2009
                                        14. Coursey CA et al: Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants. AJR Am J Roentgenol. 191(1):190-7, 2008
                                        15. Epelman M et al: Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 27(2):285-305, 2007
                                        16. Lambert DK et al: Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol. 27(7):437-43, 2007
                                        17. Sharma R et al: Neonatal gut barrier and multiple organ failure: role of endotoxin and proinflammatory cytokines in sepsis and necrotizing enterocolitis. J Pediatr Surg. 42(3):454-61, 2007
                                        18. Upperman JS et al: Mathematical modeling in necrotizing enterocolitis--a new look at an ongoing problem. J Pediatr Surg. 42(3):445-53, 2007
                                        19. Maayan-Metzger A et al: Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol. 24(8):494-9, 2004
                                        20. Updegrove K: Necrotizing enterocolitis: the evidence for use of human milk in prevention and treatment. J Hum Lact. 20(3):335-9, 2004
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Necrotizing enterocolitis (NEC): Poorly understood but life-threatening condition of neonatal GI tract characterized by inflammation, ischemia, & translocation of bacteria into bowel wall
                                                • Very low birth weight (VLBW) infant: < 1,500 g
                                                • Extremely low birth weight (ELBW) infant: < 1,000 g

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • Ultrasonographic Findings

                                                    • Fluoroscopic Findings

                                                      • CT Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Baskin H. Practical Pediatric Imaging: Practical imaging. https://itun.es/us/JnCQM.l Reviewed March 30, 2016. Accessed March 30, 2016
                                                                              2. He Y et al: Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 105(4):e151-5, 2016
                                                                              3. Lau CS et al: Probiotic administration can prevent necrotizing enterocolitis in preterm infants: A meta-analysis. J Pediatr Surg. 50(8):1405-12, 2015
                                                                              4. Zani A et al: Necrotizing enterocolitis: controversies and challenges. F1000Res. 4, 2015
                                                                              5. Markel TA et al: Predicting disease severity of necrotizing enterocolitis: how to identify infants for future novel therapies. J Clin Neonatol. 3(1):1-9, 2014
                                                                              6. Yikilmaz A et al: Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatr Surg Int. 30(12):1231-40, 2014
                                                                              7. Muchantef K et al: Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 43(11):1444-52, 2013
                                                                              8. Sharma R et al: A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol. 40(1):27-51, 2013
                                                                              9. Silva CT et al: A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit. Pediatr Radiol. 43(11):1453-63, 2013
                                                                              10. Yee WH et al: Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 129(2):e298-304, 2012
                                                                              11. Hollingsworth CL et al: The Duke Abdominal Assessment Scale: initial experience. Expert Rev Gastroenterol Hepatol. 4(5):569-74, 2010
                                                                              12. Ryan S et al: Gastrointestinal pathology in neonates: new imaging strategies. Pediatr Radiol. 40(6):927-31, 2010
                                                                              13. Coursey CA et al: Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis. AJR Am J Roentgenol. 193(5):1408-13, 2009
                                                                              14. Coursey CA et al: Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants. AJR Am J Roentgenol. 191(1):190-7, 2008
                                                                              15. Epelman M et al: Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 27(2):285-305, 2007
                                                                              16. Lambert DK et al: Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol. 27(7):437-43, 2007
                                                                              17. Sharma R et al: Neonatal gut barrier and multiple organ failure: role of endotoxin and proinflammatory cytokines in sepsis and necrotizing enterocolitis. J Pediatr Surg. 42(3):454-61, 2007
                                                                              18. Upperman JS et al: Mathematical modeling in necrotizing enterocolitis--a new look at an ongoing problem. J Pediatr Surg. 42(3):445-53, 2007
                                                                              19. Maayan-Metzger A et al: Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol. 24(8):494-9, 2004
                                                                              20. Updegrove K: Necrotizing enterocolitis: the evidence for use of human milk in prevention and treatment. J Hum Lact. 20(3):335-9, 2004