N.E.

C
Necrotizing Enterocolitis
(Enterokolitis Nekrotikans)

Definisi 
Necrotizing 
kematian jaringan 

Entero 
saluran pencernaan (usus halus) 

Colli 
saluran pencernaan (usus besar) 

-itis 
peradangan

Definisi
‡ Kegawatan (emergencies) abdomen pada bayi baru lahir (bayi prematur) ‡ 1 ± 2 minggu pertama kehidupan ‡ Ditandai dengan peradangan pada saluran cerna (usus halus dan usus besar) sampai dengan kematian jaringan (nekrotisasi) akibat berbagai faktor
http://kidshealth.org/parent/medi cal/digestive/nec.html

Anatomi Saluran Cerna

http://www.mountnittany.org/ass ets/images/krames/85061.jpg

http://go2.wordpress.com/?id=725X1342&site=usebrains.wo rdpress.com&url=http%3A%2F%2Fusebrains.files.word press.com%2F2008%2F11%2Fclip-image002.jpg

Anatomi Saluran Cerna

http://www.lighterliving.com/uploads/images/intestinaldiagram.jpg

Saluran Cerna Bayi Prematur
‡ ‡ ‡ ‡ ‡ IgA, Limfosit T Respon Antibodi Permeabilitas membran epitel GI Motilitas GI Lapisan Mucin tipis dan permeabel

McElroy, Steven M.D.:Neonatal NEC pp 34.Vanderbilt University.Vanderbilt Children Hospital.April 2008

Predileksi NEC

Ileum terminalis - caecum
http://medimages.healthopedia.com/ large/necrotizing-enterocolitis.jpg

Epidemiologi

http://knol.google.com/k/-/-/Mpv6w2_G/cMzxJA/fig%201.jpg

Faktor Resiko

Carol Rees Parish, R.D.: NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #59, Practical Gastroenterology, February 2008

Patofisiologi

Faktor Defensive Usus

http://neoreviews.aappublications.org ± Jesse, Nathan M.D.;Necrotizing Enterocolitis: relationship to innate immunity, Clinical features, and Strategies for Prevention

aq

http://knol.google.com/k/-/-/Mpv6w2_G/cMzxJA/fig%208.jpg

Diagnosis NEC
‡ Modifikasi kriteria Bell¶s Staging oleh Walsh dan Kliegmann ‡ 3 stadium
1. Suspected NEC 2. Proven / Definite NEC 3. Advanced / Severe NEC
http://knol.google.com/k/-//Mpv6w2_G/cMzxJA/fig%202.jpg

Diagnosis NEC

Stadium I ± Suspected NEC
‡ Faktor ± faktor resiko untuk terjadinya stress perinatal Instabilitas suhu tubuh, disertai keadaan letargi, apnoe, bradikardia Gejala saluran pencernaan, bayi malas makan, meningkatnya residu saluran pencernaan, emesis, distensi abdomen ringan, tes darah samar feces positif Gambaran radiologis densitas ringan, dilatasi lumen usus

‡

‡

‡

‡ Gambaran Radiologis

Normal

Dilatasi lumen

Stadium II ± Proven NEC
‡ Gejala seperti stadium I, tetapi:
± Distensi abdomen lebih berat ± Bising usus menghilang ± Perdarahan lewat tinja lebih jelas (gross bleeding) ± Asidosis metabolik ringan ± Radiologis:
‡ pneumatosis intestinalis ‡ portal vein gas ‡ tanda ± tanda ascites

Stadium III ± Advanced NEC
‡ Gejala 2 stadium sebelumnya ditambah:
± tanda ± tanda shock (septic), ± peritonitis generalisata, ± eritema pada abdomen ± Radiologis
‡ pneumoperitoneum

Pneumoperitoneum (football sign)

Tatalaksana
‡ ‡ ‡ ‡ ‡ Puasa (NPO) dan oksigenasi adekuat Selang hidung-lambung (NGT) Infus untuk cairan dan nutrisi cukup Antibiotik Pemeriksaan serial foto polos abdomen

Tatalaksana
‡ Nutrisi

‡ Antibiotik
± Clindamycin 15 ± 40 mg/kg/hari terbagi 3-4x; ± Gentamycin 2,5 mg/kg/x, 1-2x/hari ± Metronidazole 7,5 ± 15 mg/kg/hari

II A

II B

III A

III B

Indikasi Pembedahan
‡ Absolut:
± Perforasi pneumoperitoneum ± Perburukan gejala klinis dengan terapi maksimal ± Obstruksi intestinal ± Sepsis ± Jaringan nekrotik striktura

‡ Relatif:
± Perubahan warna dinding perut yang progresif ± Looping dan dilatasi usus serta pneumatosis intestinalis bermakna pada foto polos ± Portal Vein Gas

Surgery

Peritoneal Drainage

Laparatomy

‡ VLBW - Severe NEC ‡ Tidak ada kemajuan klinis selama 12 ± 24 jam laparatomi

‡ Gangren - Sepsis ‡ penentuan: ‡ Reseksi dan enterostomi ‡ Reseksi dan anastomosis primer ‡ Diverting jejunostomi

Komplikasi
‡ Komplikasi penyakit dan tindakan:
± Asidosis metabolik ± DIC ± Peritonitis ± Abses ± Striktura ± Short gut ± syndrome ± Neurodevelopmental delay (50% pasien)

Prognosis
‡ Angka mortalitas 25 % ‡ Dapat pulih dan tidak mengalami gangguan pencernaan stadium dini terdiagnosis, tanpa komplikasi

Pencegahan
‡ ASI untuk bayi ± bayi baru lahir ‡ Probiotik

Air Susu Ibu
‡ Faktor anti infeksi
± pH rendah
‡ menghalangi pertumbuhan kuman colliform dan jamur

± Meningkatkan kadar lisozym Bakterisid ± Laktoferin-laktoperoksidase ± Induksi imunitas enterik pasif
‡ SIgA ‡ Sel T ‡ Sel B

± Pengendalian flora usus (prebiotik-FOS,GOS)

‡ Faktor osmolaritas
± Hiposmolaritas ASI

Probiotik
‡ ‡ ‡ ‡ Mikroorganisme hidup Saluran cerna manusia Jumlah cukup Bermanfaat

Probiotik
‡ 95% di ASI ‡ Muncul hari ke ± 7 ‡ homofermentasi

Prebiotik
‡ NDO (non digestableoligosaccharides):
± FOS (Fructo-Oligosaccharides) ± TOS (TransgalactoOligosaccharides) ± Lactulose

Daftar Pustaka
1. Avery, Gordon. B M.D., Ph.D. Neonatology: Pathophysiology and Management of the Newborn 3rd edition. pp 1220 ± 1222:Section 47. Nutrition, Disorder of Nutrition. Fletcher, Anne B. Philadelphia: J. B. Lippincott Company.1987. 2. Bourlioux, Pierre et al. The Intestine and Its Microflora are Partners for the Protection of the Host: report on the Danone Symposium ³The Intelligent Intestine´. Am Jou of Clinical Nutrition. 2002. Diunduh dari www.ajcn.org 3 Maret 2010. 3. Epelmann, Monica M. D. et al. Necrotizing Enterocolitis: Review of State-of-the-Art Imaging Findings with Pathologic Correlation. Radio Graphics Vol. 27:285 ± 305. 2007. Diunduh dari: radiographics.rsna.org/content/27/2/285.full 3 Maret 2010. 4. Gomella, Tricia Lacy, M. Douglas Cunningham, Fabien Gabriel Eyal, Karin E. Zenk. Neonatology: Management, Procedures, On-call Problems, Diseases, and Drugs 5th edition. pp 482 ± 487: Section 71. Necrotizing Enterocolitis and Spontaneous Intestinal Perforation.University of Michigan: Lange Medical Books.2004. 5. Hackam, David J M. D, Ph.D. Necrotizing Enterocolitis: A Leading Cause of Death and Disability in Newborn Children. Diunduh dari: http://knol.google.com/k/necrotizing-enterocolitis# 3 Maret 2010. 6. Henry Marion C. W M.D., R. Lawrence Moss, M.D. Surgical Therapy for Necrotizing Enterocolitis: Bringing Evidence to the Bedside. Diunduh dari: www.uftm.edu.br/discirped/textos/AVIdiscirped070102093945.pdf 4 Maret 2010 7. Jesse, Nathan and Josef Neu. Necrotizing Enterocolitis: Relationship to Innate Immunity, Clinical Features, and Strategies for Prevention. NeoReviews 2006;7;e143-e150. Diunduh dari: http://neoreviews.aappublications.org/cgi/content/full/neoreviews;7/3/e143 8. Reuters Health Information. SGA Preemies Face Excess Mortality from Lung Disease and Necrotizing Enterocolitis. Diunduh dari: http://www.medscape.com/viewarticle/709365. 3 Maret 2010. 9. Reuters Health Information. Human-Milk-Only Diet Lowers Necrotizing Enterocolitis Risk in Preemies. Diunduh dari: http://www.medscape.com/viewarticle/715321. 4 Maret 2010. 10. Springer, Shelley C M.D. Necrotizing Enterocolitis: Overview etc. Diunduh dari: http://emedicine.medscape.com/article/977956 3 Maret 2010.

Sign up to vote on this title
UsefulNot useful