Term
| 2 most important risk factors for development of necrotizing enterocolitis. |
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Definition
Very low birth weight (<1500 g)
Gestational age at birth |
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Term
| Group of patients with highest mortality from NEC. |
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Definition
| Very low birth weight (VLBW) infants who are black and male. |
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Term
| Histologic findings of NEC. |
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Definition
| Inflammation and coagulative necrosis (present in over 90% of surgical specimens) |
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Term
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Definition
| Air within intestinal wall. Finding in NEC thought to be due to bacterial overgrowth and gas production. |
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Term
| The current consensus on the pathogenesis and pathophysiology of NEC. |
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Definition
| Some insult -> over-exuberent inflammation -> epithelial disruption -> bacteria translocation - normal immunosuppressive mechanisms are not functional due to stress. Ultimately global inflammation occurs. |
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Term
| Name 3 mechanical factors that contribute to the impermeable nature of the intestinal barrier. |
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Definition
Peristalsis
Mucous coat
Tight junctions |
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Term
| Mature tight junctions are made up of the transmembrane proteins... (name 3). |
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Definition
occludin
claudin
junctional adhesion protein |
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Term
| 4 important cell types in gut-associated lymphoid tissue. |
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Definition
Macrophages
Dendritic cells
M cells overlying Peyer's patches
Paneth cells in crypts |
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Term
| Name a potential modifiable protective protective factor for NEC in premature infants. |
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Definition
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Term
| This mediator is normally involved in vasodilation, but may be excessively high in NEC due to an increase of the enzyme that makes it in enterocytes by inflammatory mediators. |
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Definition
| NO. Inflammatory mediators increase iNOS (inducible nitric oxide synthase). Importantly, eNOS (endothelial NOS) is constitutively expressed in enterocytes. |
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Term
| Name 2 methods of intrinsic control of vascular resistance by vessels in infants intestines (and in general). |
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Definition
Endothelin is a vasoconstrictor increased in premies
NO a vasodilator |
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Term
| 4 early nonspecific signs of NEC. |
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Definition
Apnea
Bradycardia
Lethargy
Temperature instability |
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Term
| What are the levels of the Bell staging system of NEC? |
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Definition
I - suspected
IIa - definite
IIb
IIIa - advanced
IIIb |
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Term
| Name the clinical, radiographic and gastrointestinal findings of Bell stage I NEC. |
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Definition
C: Apnea, bradycardia, temperature instability
R: Gas pattern of mild ileus
G: Increased gastric residuals, occult blood in stool, mold abdominal distension |
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Term
| Name the clinical, radiographic and gastrointestinal findings of Bell stage IIa NEC. |
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Definition
C: Apnea, bradycardia, temperature instability
R: Ileus gas pattern with dilated loops, focal pneumatosis
G: Grossly bloody stools, prominent abdominal distension, absent bowel sounds |
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Term
| Name the clinical, radiographic and gastrointestinal findings of Bell stage IIb NEC. |
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Definition
C: Thrombocytopenia, mild metabolic acidosis
R: Widespread pneumatosis, ascites, portal venous gas
G: Abdominal wall edema with palpable loops and tenderness |
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Term
| Name the clinical, radiographic and gastrointestinal findings of Bell stage IIIa NEC. |
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Definition
C: Mixed acidosis, oliguria, hypotension, coagulopathy
R: Prominent bowel loops, worsening ascites, no free air
G: Worsening wall edema, erythema and induration |
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Term
| Name the clinical, radiographic and gastrointestinal findings of Bell stage IIIb NEC. |
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Definition
C: Shock, deterioration in laboratory values and vital signs
R: Pneumoperitoneum
G: Perforated bowel |
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Term
| Most important radiographic test for the diagnosis of NEC. |
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Definition
| Plain films: AP, cross lateral, or left lateral decubitus. |
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Term
| Most specific radiographic finding indicating NEC. |
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Definition
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Term
| Two most critical elements of the differential of a premature infant with abdominal distention. |
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Definition
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Term
| Initial medical treatment of NEC when it is suspected. |
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Definition
Bowel rest
Gastric decompression
IVF resuscitation
Broad-spectrum antibiotics including anaerobes |
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Term
| A promising experimental medical treatment for NEC. |
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Definition
| Heparin binding-EGF (HB-EGF) |
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Term
| The only absolute indication for surgical intervention in NEC. |
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Definition
| Intestinal perforation either on abdominal radiograph or via paracentesis that is positive for stool or bile |
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Term
| Three findings with high PPV of 100% and prevalence >10% for when to perform surgery before bowel perforation in NEC. |
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Definition
Pneumoperitoneum
Portal venous gas
Positive paracentesis |
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Term
| Anatomical structure that, when preserved, may be associated with a much less risk of short gut syndrome. |
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Definition
| Ileum, and perhaps the ileocecal valve |
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Term
| ______ are the most common complication after both medically and surgically treated NEC. |
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Definition
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Term
| 3 gastrointestinal outcomes of NEC. |
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Definition
Short bowel syndrome
Stoma complications
Intestinal strictures |
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Term
| The most clearly established risk factor for NEC. |
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Definition
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Term
|
Definition
| An excessive and uncontrolled inflammatory response by the neonatal intestine after exposure to some inciting event. |
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