Surgical Intervention for the Treatment of Enterocolitis
Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease occurring in 1% to 5% of all neonatal intensive care unit (NICU) admissions. Although the majority of infants diagnosed with NEC are treated with medical management, up to 25% to 50% will require surgery. Surgical intervention is associated with significant morbidity and mortality, especially in the extremely low birth weight infant. To decrease the complication rate for these infants, a number of surgical procedures are advocated, including the traditional laparotomy with resection, primary anastomosis, the "patch, drain, and wait" approach, the "clip and drop" technique, and bedside peritoneal drainage. Here we examine current surgical interventions for the treatment of NEC with an emphasis on bedside peritoneal drainage. Management of idiopathic perforation with peritoneal drainage is also discussed because of its similarity to NEC. Neonatal nurses must understand the various surgical procedures to better address the concerns of parents and to provide optimal nursing care of the infant with NEC.
Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease occurring in 1% to 5% of all neonatal intensive care unit (NICU) admissions. It is an acquired disease, producing inflammation and necrosis of the mucosal and submucosal layers of the intestinal tract and often leading to perforation. NEC is considered the most common gastrointestinal emergency seen in the NICU, with a mortality rate of 10% to 50%, increasing to nearly 70% for those infants with extensive disease. The mortality rate for NEC exceeds that of all other gastrointestinal conditions requiring surgery combined. For infants who survive NEC, complications, including strictures, short bowel syndrome, sepsis, and total parenteral nutrition-related problems, increase their morbidity significantly. Most infants diagnosed with NEC can be managed medically; however, up to 25% to 50% of infants will require surgical intervention. The surgical success for NEC has significantly improved in the last few decades because of advances in neonatal care; however, the mortality and morbidity rate for these vulnerable infants remains high. When that infant is extremely premature with a birth weight less than 1,000 grams, the chances of survival may be as low as 20%. This article discusses the current status of surgical intervention for the treatment of NEC, including traditional and more innovative approaches. The use of bedside peritoneal drains in the treatment of perforated NEC is emphasized. It is important for neonatal and infant nurses caring for infants with NEC to understand the various surgical interventions used in the management of these infants. A thorough understanding of these procedures enables the nurse to provide better care for the infant and his/her family.
Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease occurring in 1% to 5% of all neonatal intensive care unit (NICU) admissions. Although the majority of infants diagnosed with NEC are treated with medical management, up to 25% to 50% will require surgery. Surgical intervention is associated with significant morbidity and mortality, especially in the extremely low birth weight infant. To decrease the complication rate for these infants, a number of surgical procedures are advocated, including the traditional laparotomy with resection, primary anastomosis, the "patch, drain, and wait" approach, the "clip and drop" technique, and bedside peritoneal drainage. Here we examine current surgical interventions for the treatment of NEC with an emphasis on bedside peritoneal drainage. Management of idiopathic perforation with peritoneal drainage is also discussed because of its similarity to NEC. Neonatal nurses must understand the various surgical procedures to better address the concerns of parents and to provide optimal nursing care of the infant with NEC.
Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease occurring in 1% to 5% of all neonatal intensive care unit (NICU) admissions. It is an acquired disease, producing inflammation and necrosis of the mucosal and submucosal layers of the intestinal tract and often leading to perforation. NEC is considered the most common gastrointestinal emergency seen in the NICU, with a mortality rate of 10% to 50%, increasing to nearly 70% for those infants with extensive disease. The mortality rate for NEC exceeds that of all other gastrointestinal conditions requiring surgery combined. For infants who survive NEC, complications, including strictures, short bowel syndrome, sepsis, and total parenteral nutrition-related problems, increase their morbidity significantly. Most infants diagnosed with NEC can be managed medically; however, up to 25% to 50% of infants will require surgical intervention. The surgical success for NEC has significantly improved in the last few decades because of advances in neonatal care; however, the mortality and morbidity rate for these vulnerable infants remains high. When that infant is extremely premature with a birth weight less than 1,000 grams, the chances of survival may be as low as 20%. This article discusses the current status of surgical intervention for the treatment of NEC, including traditional and more innovative approaches. The use of bedside peritoneal drains in the treatment of perforated NEC is emphasized. It is important for neonatal and infant nurses caring for infants with NEC to understand the various surgical interventions used in the management of these infants. A thorough understanding of these procedures enables the nurse to provide better care for the infant and his/her family.