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Lukić Stefan stefanlukic@gmail.

com

Uvod
 Nekrotični Enterokolitis (NEC) je najčešća životno

ugrožavajuća bolest gastrointestinalnog sistema neonatusa i karakteriše se varijabilnim stepenom nekroze mukoze ili celog zida creva.  NEC je bolest nepoznate etiologije

Sharma R. Biomarkers for Infants at Risk for Necrotizing Enterocolitis: Clues to Prevention? Pediatric Research.n. Handfield M. 2.14:2142.Young C. 2009.6%3 (P<0. J Paediatr Child Health. Necrotizing enterocolitis: A multifactorial disease with no cure. Mai V. incidenca 6.n. Luig M. VS 27-31 g. 2008.65:91R-97R.Epidemiologija      SRBIJA – nepoznata epidemiologija  Oko 2500 slučajeva godišnje u SAD. Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. Neu J. Lui K.41(4):174-179.001) 47-14% dece u grupi veoma niske TM oboli od NEC1-3 1. 2005. 10% terminska2 1-5% sve dece primljene u NIN razvija NEC2 24-27 g. World Journal of Gastroenterology. 3. . 20-28 % ne prežive1 90% preterminska novorođenčad. Schnabl K-L.6% vs 2.

Content Providers(s): CDC/Dr. Edwin P.ID#: 856 Description: Gross pathology of neonatal necrotizing enterocolitis. Jr. Creation Date: 1972 . pneumatosis intestinalis. Autopsy. Alimentary tract of infant showing intestinal necrosis. Ewing. and perforation site (arrow).

27:285-305 .Epelman M. Radiographics. Navarro OM. et al. Daneman A. Necrotizing Enterocolitis: Review of State-of-the-Art Imaging Findings with Pathologic Correlation. 2007. .

Risk factors for necrotizing enterocolitis in preterm infants: how race.123:58-66 . Schnabl K-L. gender. Necrotizing Enterocolitis. Luig M.364(3):255-264. . hiposekrecija HCl u želucu i upotreba H2 blokatora. Carter BM. Stoll B.Etiologija  Sigurno: Mala porođajna masa. Necrotizing enterocolitis: A multifactorial disease with no cure. J Paediatr Child Health. Walker WA. World Journal of Gastroenterology. ishrana formulom. N Engl J Med. Stroll B. 18th E ed. In: Kliegman R.14:2142. 4. Philadelphia :: Saunders Elsevier. Neu J. 2005. 6. Lui K. 5. 2. Cotten CM. Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. 2009. 3. ed. Adv Neonatal Care. Taylor S. Nelson textbook of pediatrics.. 2008.41(4):174-179. 2011. Neonatal Necrotizing Enterocolitis (NEC). Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants. Pediatrics. prematuritet. crna rasa i profilaktička upotreba antibiotske terapija duže od 5 dana (neonatusi ispod 1000g) 1-6 1. 2008. et al. upotreba mehaničke ventilacije. perinatalna asfiksija1-6  Verovatno: Prethodne infekcije.8(5):285-290. Holditch-Davis D. and health status contribute. 2007. Piazza A.

Gaul A.1982. Neonatal Necrotizing Enterocolitis -Inflammation and Intestinal Immaturity.Etiologija  Klasične Mikrobiološke tehnike ne otkrivaju 80% enteričke flore 1  Cum hoc ergo propter hoc Vs Koch  Bifidobacter-Lactobacillus Vs Enterobacteriae 2. 2. Bates J. Diversity of the human intestinal microbial flora. Pathogenesis of neonatal necrotising enterocolitis.308(5728):1635-1638. Bik EM. Bernstein CN. et al. Lancet. 2009. Lawrence G. Claud EC.Anti-Inflammatory and Anti-Allergy Agents). Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry . Science. .Eckburg PB.3 1. 2005.1(8264):137–139.8:248-259 3.

Nelson textbook of pediatrics.Etiologija Escherichia coli Clostridium difficile Cronobacter sakazakii Coronavirus Adenovirus Klebsiella Clostridium butyricum Pseudomonas aeruginosa Rotavirus Torovirus Clostridium perfringens Clostridium neonatale Staphylococcus epidermidis Coxsackie B2 Echovirus 22 Tabela 1 – Mikroorganizmi optuženi za izazivanje NEC-a 1.364(3):255-264. Lancet.Piazza A. Science. Neonatal Necrotizing Enterocolitis (NEC). . Bernstein CN. 5. Bik EM. ed. Claud EC. Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry . 2009. Walker WA.2. Lawrence G. 2007. 2. Pathogenesis of neonatal necrotising enterocolitis. Diversity of the human intestinal microbial flora.Anti-Inflammatory and Anti-Allergy Agents). Neu J.5 1. N Engl J Med. Philadelphia :: Saunders Elsevier. Neonatal Necrotizing Enterocolitis -Inflammation and Intestinal Immaturity. In: Kliegman R.1(8264):137–139 4.8:248-259 3.4.Eckburg PB. 2005.308(5728):1635-1638.. Bates J. 2011. et al. Necrotizing Enterocolitis. Gaul A.1982.3. Stroll B. 18th E ed.

Patogeneza Prematuritet Smanjena digestivna sposobnost Intestinalna nezrelost: Smanjen motilitet Smanjena regulacija cirkulacije Smanjena barijerna funkcija Nezreo imunitet Hipoksično ishemična povreda NEC Abnormalna bakterijska kolonizacija Ishrana mlečnom formulom .

Patogeneza  Nf-Kb  LPS  TLR4  Il-8  IFN-y  ET1  NO  PAF .

292(5):G1347 -G1358. American Journal of Physiology . Nitric oxide inhibits enterocyte migration through activation of RhoA-GTPase in a SHP-2-dependent manner. Leaphart CL. Li J. et al. 2007. Cetin S.N i t r o t y r o s i n e 1. .Gastrointestinal and Liver Physiology.

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2007. . et al. Cavallo J. The Journal of Immunology.179(7):4808 4820. A Critical Role for TLR4 in the Pathogenesis of Necrotizing Enterocolitis by Modulating Intestinal Injury and Repair.Patogeneza  Leaphart CL. Gribar SC.

Claud EC. The FASEB Journal. Hypothesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis. 2001.1. .15:1398-1403.

3. odbijanje hrane. niža gestaciona starost .3 1. Bell MJ. Piazza A. Nelson textbook of pediatrics. Neonatal necrotizing enterocolitis. Ternberg JL. Therapeutic decisions based upon clinical staging.3  GIT tetrada: povraćanje. Walker WA. Stroll B.2. hipotenzija. letargija. distenzija abdomena i krv u stolici 1. 2007. et al.2. 1978. Philadelphia :: Saunders Elsevier. Kusmaul-ovo disanje (metabolička acidoza) 1. bradikardija. Feigin RD.Prezentacija  Veća gestaciona starost – ranija prezentacije.364(3):255-264. Surg.187(1):1-7 .3  Sistemski znaci i simptomi: apnea.. ed. Neonatal Necrotizing Enterocolitis (NEC). Ann. 2011. 18th E ed. 2.kasnija prezentacija 1. . Necrotizing Enterocolitis. N Engl J Med. In: Kliegman R. Neu J. poremećaj svesti.2.

wikispaces.com/Necrotizing+Enterocolitis. 2011. . Anon.1. MIcrobiologySpring2010 . Accessed November 21.Necrotizing Enterocolitis. Available at: http://microbiologyspring2010.

3. Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry .Anti-Inflammatory and Anti-Allergy Agents). Necrotizing enterocolitis: A multifactorial disease with no cure. Necrotizing Enterocolitis.5 1. 2011... 18th E ed. 2007. Schnabl K-L. Bell MJ. Neonatal Necrotizing Enterocolitis (NEC). (1. ed. Surg. .3)  Specifični markeri samo u istraživačke svrhe: IL-8. parcijalno tromboplastinsko vreme (PTT) i fibrin degradacioni produkti (FDP) (1. pneumatosis intestinalis. sEGF 2.8:248-259.2. Ann.3)  DIK : Protrombinsko vreme (PT). 2008. Stroll B. sniženje albumina.187(1):1-7. MRI abdomena: slobodan vazduh.2. CT.364(3):255-264.3)  Laboratorija: povišen CRP. 2009. Walker WA. Therapeutic decisions based upon clinical staging. Claud EC. Neu J. PAF. TNFa. H2 izdisajni test. uEGF. Philadelphia :: Saunders Elsevier.Piazza A. Neonatal necrotizing enterocolitis.4. elevaciju jetrinih enzima. Neonatal Necrotizing Enterocolitis -Inflammation and Intestinal Immaturity.2. 1978. prokalcitonin. N Engl J Med. portalni gas (1. In: Kliegman R. 2.. Nelson textbook of pediatrics. World Journal of Gastroenterology. Feigin RD. et al. 4.Prezentacija  Nativna radiografija.14:2142 5. Ternberg JL.

20(5):1213 -1224. Radiographics. Quiroga S. Espin E.1. Portomesenteric Vein Gas: Pathologic Mechanisms. 2000. . Sebastià C. et al. CT Findings. and Prognosis1.

video. US.1. pneumobilia. 2011. wall. ischemia. system.portal. Welcome to LearningRadiology . website. biliary. radiology. ischemic. infarction. causes. arterial. image. best. Accessed November 21. radiology. web. air.com/archives2009/COW%20360-Portal%20venous%20gas/portalgascorrect.htm. mesenteric. vodcast. CT. pneumatosis. intestinalis. plain. xray. jpg. medical. student. x-ray. podcast. death. teaching. Available at: http://www.learningradiology. jpeg. necrosis. Anon. venous. film. . bowel. imaging. gas. site.

.learningradiology.com . LearningRadiology.1. NEC.necrotizing enterocolitis.htm.com/archives05/COW%20156NEC/neccorrect. 2011. Available at: http://www. Accessed November 21. Anon.

Ann. 2007. (1.2. 1978. Neonatal necrotizing enterocolitis. Feigin RD.364(3):255-264. .Dijagnostika  Ne čekati potvrdu dijagnoze već otpočeti terapiju. 2. 3. Nelson textbook of pediatrics. Bell MJ. 2011. Ternberg JL. Philadelphia :: Saunders Elsevier. Surg.Piazza A. N Engl J Med. In: Kliegman R.3)  Koristiti Bell kriterijume (1. Stroll B. ed.187(1):1-7. et al. Neu J.3) 1. Neonatal Necrotizing Enterocolitis (NEC)..2. Therapeutic decisions based upon clinical staging. Necrotizing Enterocolitis. Walker WA. 18th E ed.

pneumatosis abdominalni bol na intestinalis palpaciju IB (Sumnjiv) IIA (Dokazan) IIB (Dokazan) Iznad + metabolička Isto kao iznad + jači Isto kao iznad + gas u portalnoj veni + ascites acidoza + abdominalni bol trombocitopenia Iznad + hipotenzija. odsutna peristaltika + ileus.Stadijum IA (Sumnjiv) Sistemski znaci Intestinalni znaci Radiološki znaci Nestabilnost Otežano hranjenje. blagi ileus blaga abdominalna distenzija Isto kao iznad Isto kao iznad Isto kao iznad + sveža Isto kao iznad krv u stolici Isto kao iznad I Intestinalna dilatacija. Normalno ili temperature. Poor intestinalna dilatacija. distenzija abdomena neutropenia Isto kao iznad Isto kao iznad Iznad + pneumoperitoneum IIIA (Razvijen) IIIB (Razvijen) . letargija feeding. povraćanje. apnea. povraćanje. peritonitis. bradikardija. Isto kao iznad + Isto kao iznad + veća izrazita količina ascitesa respiratorna acidoza.

18th E ed.. N Engl J Med. ed. Nelson textbook of pediatrics.2  Potrebna je energična borba protiv šoka. 2011.Terapija  Preporuke se baziraju na “konsenzusu stručnjaka”  Ne postoje korektni klinički trajali  Prva mera mora biti uvođenje Nil per os i izolacija pacijenta uz primeni higijenskig mera pri kontaktu 1.2  DIK je stalni pratioc pa treba pratiti PT. In: Kliegman R. Neonatal Necrotizing Enterocolitis (NEC). Philadelphia :: Saunders Elsevier.364(3):255-264 . 2007.i anaeroba je opravdana 1. G. Neu J. Stroll B. Walker WA.2  Upotreba antibiotika sa dejstvom protiv G+. Necrotizing Enterocolitis. 2.2 1.Piazza A. PTT i FDP i energično se boriti protiv DIK-a 1. korekcija acidoze. nadoknada tečnosti i dekompresija plasiranjem NG sonde 1.

N Engl J Med. 18th E ed. ed. Pediatrics. 2011. 2006.117(4):e680-687 . Blakely ML. 2007.. Nelson textbook of pediatrics. In: Kliegman R. Walker WA.2  Perforacija i prisustvo bakterija u ascitu indikacija za hiruršku terapiju 1. Neonatal Necrotizing Enterocolitis (NEC). Tyson JE. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Lally KP.2.Terapija  Serijske radiografije se preporučuju ali ne postoje dokazi da potvrde ili opovrgnu 1. Neu J. Philadelphia :: Saunders Elsevier. 2. et al.364(3):255-264 3. Stroll B.3 1.2  Ne preporučuje se peritonealna drenaža već “klasična” laparotomija sa eventualnom resekcijom 1.Piazza A. Necrotizing Enterocolitis.

Neu J.Prevencija Tabela 2 – Preporuke po Neau i Walker-u (1) 2. 2011.364(3):255-264 . N Engl J Med. Walker WA. Necrotizing Enterocolitis.

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Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter. Oral probiotics prevent necrotizing enterocolitis in very low birth weight infants. Chen HL.in HC.122:693-700 2.147:192-196 . et al. J Pediatr 2005. Hsu CH.Prevencija 1. Bin-Nun A. randomized. Pediatrics 2008. Wilschanski M. Bromker R. et al. controlled trial.