NECROTIZING ENTEROCOLITIS IN THE TERM NEWBORN INFANT

Necrotizing enterocolitis (NEC) is generally associated with prematurity. However 5-25% of infants with NEC can be term newborns (TNB). Etiology is unknown and pathogenesis is considered m ultifactorial. This study describes possible risk factors and main issues in TNB with NEC. We retrospectively analyzed possible risk factors in the records of TNB (=> 37 weeks GA) with proven NEC (=> 2 of Bell's criteria) admitted to the NICU between 4/88 and 4/93. Of proven NEC, 42% were in TNB with a mean birth weight of 3170 gms. Seven of them had asphyxia, 8 polycythemia, 7 had received an exchange transfusion, and 4 had heart failure. Fifteen TNB had associated pathologic conditions: 4 anno-rectal malformations, 7 congenital heart disease, and 1 each with meningomyelocele, toxoplasmosis and megacolon. Mean age age at diagnosis was 12 days (1-60); 60% of TNB had been previously fed. Bacteria (mostly Gram - K. Pneumoniae:3) were isolated from either blood culture and/or peritoneal fluid in 8 TNB. In 18/23 TNB treatment was surgical (drainage and/or laparotomy); 5 underwent only medical management. Overall survival was 57%. These data show that TNB with known risk factors may also develop NEC and its consequences. We conclude that in TNB with these risk factors, early diagnosis and aggressive therapy can prevent severe NEC and its possible sequelae.