Microbiology and management of neonatal necrotizing enterocolitis
Microbiology and management of neonatal necrotizing enterocolitis
复制标题
DOI：
10.1055/s-2008-1040346
复制
发表时间：
2008-02-01
影响因子：
2
通讯作者：
Brook, Itzhak
中科院分区：
文献类型：
--
作者：
Brook, Itzhak
坏死性小肠结肠炎（Necrotizing enterocolitis，NEC）是一种肠缺血性坏死的临床综合征，其病因包括肠缺血、异常菌群植物群和肠粘膜不成熟。大量研究表明，粪便中的微生物菌群可能参与NEC的发病机制。从NEC婴儿的腹膜腔和血液中回收了通常在远端胃肠道中发现的广泛微生物。主要生物体包括肠杆菌科（即，大肠杆菌，肺炎克雷伯氏菌），梭菌属，肠道病原体（沙门氏菌、科萨基B2病毒、冠状病毒、轮状病毒）和潜在病原体（脆弱拟杆菌）。初始管理的目标是防止持续损伤，恢复止血，并尽量减少并发症。医疗管理包括停止口服喂养，放置鼻胃管，腹部减压，穿刺术，含有电解质和热量的剧烈静脉补液，支持循环，给予抗生素，以及监测需要手术干预的恶化或并发症。手术指征包括临床恶化、穿孔、腹膜炎、梗阻和腹部肿块。预防对于降低NEC的发病率仍然至关重要。预防方法包括谨慎的喂养方案，使用母乳和使用益生菌。
Necrotizing enterocolitis (NEC) is a clinical syndrome of ischemic necrosis of the bowel of multiple etiological factors that include the presence of intestinal ischemia, abnormal bacterial flora, and intestinal mucosal immaturity. Numerous reports have implied that the fecal microflora may contribute to the pathogenesis of NEC. A broad range of organisms generally found in the distal gastrointestinal tract have been recovered from the peritoneal cavity and blood of infants with NEC. The predominant organisms include Enterobacteriaceae (i.e., Escherichia coli, Klebsiella pneumoniae), Clostridium spp., enteric pathogens (salmonellae, Coxsackie B2 virus, coronavirus, rotavirus), and potential pathogens (Bacteroides fragilis). The goals of the initial management is preventing ongoing damage, restoring hemostasis, and minimizing complications. Medical management includes withholding oral feeding, placement of nasogastric tube, abdominal decompression, paracentesis, vigorous intravenous hydration containing electrolytes and calories, support of the circulation, administration of antibiotics, and surveillance for deterioration or complications that require surgical intervention. Indications for surgery include clinical deterioration, perforation, peritonitis, obstruction, and abdominal mass. Prevention remains crucial to decrease the incidence of NEC. Preventive methods include cautious feeding regimens, the use of maternal breast milk, and the use of probiotics.