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Necrotizing Enterocolitis

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Necrotizing Enterocolitis Presented by Dr Akram Sa ade Moderator: Dr Yousef Abu Osba History Ahmed is a newborn male baby , a product of caesarean section at 27 ... – PowerPoint PPT presentation

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Title: Necrotizing Enterocolitis


1
Necrotizing Enterocolitis
  • Presented by Dr Akram Saade
  • Moderator Dr Yousef Abu Osba

2
History
  • Ahmed is a newborn male baby , a product of
    caesarean section at 27 week gestational age
    due to antepartum hemorrhage on 28 July 2003 in a
    major hospital in Amman.

3
Cource in the referral hospital
  • The baby was immediately admitted and treated as
    a case of
  • -Respiratory Distress Syndrome.
  • -Suspected Sepsis.

4
Course in the referral hospital
  • Put on mechanical ventilator.
  • Covered by Ampicillin and ceftazidime.
  • Given Pentaglobin.
  • Received 3 doses of surfactant.
  • Received packed RBCs and plasma many times.

5
Course in the referral hospital
  • Feeding started at the age of 10 days but 2
    days later the baby noticed to have abdominal
    distentionfollowed by bluish discoloration of
    the skin overlying the abdomen and scrotum.
  • Feeding stopped.
  • Metronidazole added.

6
The baby referred to our NICU
  • At the age of 3 weeks as a case of
  • Prematurity.
  • Respiratory Distress Syndrome.
  • Cholestatic Jaundice.
  • Suspected Retroperitonial Hemorrhage.
  • Suspected IntraventricularHemorrhage.

7
Course in our NICU
  • The baby continued on mechanical
  • ventilator with the following setup
  • RR 15 PiP 12
  • FiO2 100 PEEP 3
  • with gradual weaning according
  • to the respiratory status.

8
Examination
  • Vital signs
  • HR 140 bpm
  • RR 40/min
  • BP 75/39mmHg
  • Temp 35.9 C

9
Examination
  • Head and Neck
  • Pale.
  • No dysmorphic features.
  • No cyanosis.
  • Normal neck examination.

10
Examination
  • Chest
  • No deformities.
  • Good air entry bilaterally.
  • Normal vesicular breathing.
  • No added sounds.

11
Examination
  • Cardiovascular
  • Normal 1st and 2nd heart sounds.
  • No murmurs.
  • Intact peripheral pulses.

12
Examination
  • Abdomen
  • Distention, abdominal girth23cm.
  • Bluish discoloration of the skin overlying
  • the abdomen.
  • Palpated mass about 2cm in diameter
  • just below the left costal margin.
  • Bilateral inguinal hernia.
  • Scrotal swelling with bluish discoloration
  • of the overlying skin.

13
Investigation
  • WBC14.9 x 10 9 N65 L25
  • PCV36 PLT75x10 9
  • Na132 meq/l K4 meq/l
  • Ca8.5 mg/dl CRP48
  • TSB8.1mg/dl Direct bilirubin3.5mg/dl
  • ABGs pH7.45 PaO2186
  • PaCO236 HCO324

14
Imaging
  • Chest X-Ray
  • Resolving respiratory distress syndrome.
  • Abdominal Ultrasound
  • Bilateral hydronephrosis ,Fluid collection.
  • Head Ultrasound
    No hemorrhage.

Chest
15
Management
  • NPO and NGT free drainage.
  • Central line.
  • IVFthat was changed according to blood glucose
    and electrlytes .
  • Packed RBCs and Plasma.
  • Metronidazole,Imipinem and Teicoplanin.
  • Pentaglobin.
  • Vitamin k.

16
  • Necrotizing Enterocolitis suspected and
    abdominal erect and supine X-rays done and
    revealed
    Multiple air fluid levels with air under the
    diaphragm ,which suggested a perforated hollow
    viscus.

17
Pediatric surgeon consultation
  • Peritoneal drainage performed, the drained
    peritoneal fluid was bloody, dirty
    and under pressure initially about
    50cc.
  • Peritoneal lavage done with Cefotaxime and
    saline.

18
  • Drain removed 5days later after clearing and
    decreasing in amount of the discharge.
  • Follow up X-Rays revealed ---no air
    fluid levels
    -disappearance of air under the diaphragm.

19
Course in the hospital
  • 10 days after admission
    Abdominal Ultrasound repeated and
    revealed
  • disappearance of fluid collection.
  • improvement of hydronephrosis.

20
Course in the hospital
  • 2 weeks after admission
    -The general condition was significantly
    improved but unfortunately the condition
  • deteriorated with development of metabolic
    and respiratory acidosis for which sepsis
    workup done that were all negative apart from
    growth of klebsiella from the ETT.
  • Imipinem and Teicoplanin discontinued.
  • Ceftazidime and Amikacin started.
  • Fluconazole added.
  • Pentaglobin given.

21
Course in the hospital
  • In the last 3 days
  • The patient developed cardiopulmonary
    compromise for which
    Dopamine and Dobutamine and NaHCO3 continuous
    infusion started . but the baby
    continued to have bradycardia and metabolic
    acidosis.

22
Course in the hospital
  • Inspite of continuous intensive
    management ,the condition deteriorated
    and the patient resuscitated
    for 3 times
  • Died on 3 AUGUST 2003.

23
Final Diagnosis
  • Prematurity.
  • Respiratory Distress Syndrome.
  • Necrotizing Enterocolitis.
  • Cholestatic Jaundice.
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