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Nursing Management for Necrotizing Enterocolitis

Necrotizing Enterocolitis (NEC) is a serious disease of the newborn gastrointestinal tract, characterized by extensive tissue death occurs in the intestinal wall. The disease is becoming one of the problems in neonates with very low birth weight (VLBW infants). In general, NEC is more common in premature neonates than full-term neonates. Risk factors causes of NEC are premature birth, early enteral feeding, the intestinal mucosal injury, and the presence of bacteria in the intestine.

Nursing Management for Necrotizing Enterocolitis
Causes

This disease most often appears in sick neonates, and is a surgical emergency that occurs most frequently among neonates. Necrotizing enterocolitis is a disease that predominantly occurs in preterm neonates. In the premature neonate, there is a lowering immunocompetence, immaturity of the gastrointestinal tract, and abnormalities of peristalsis. This can lead to maldigestion and malabsorption of nutrients that stimulate the growth of bacteria, colonization and intestinal ischemia in premature neonates. Moreover, cardiorespiratory instability, homeostatic, and poor blood flow autoregulation, causing premature neonates more susceptible to ischemic events, or hypoxia and put them at risk for NEC.


Predisposing Factors
  • Low birth weight and preterm.
  • Neonates with asphyxia.
  • Neonates with respiratory distress syndrome / recurrent apnea.
  • Neonates born PRM or other perinatal infections.
  • Neonates with umbilical vein catheterization.
  • Cyanotic congenital heart disease.
  • Hypothermia, hypotension and other general state of disorder.

Clinical Manifestation

Symptoms that appear on the NEC may occur suddenly but onset usually occurs in 1-2 weeks after birth and can occur up to several weeks. NEC onset inversely related to gestational age, where neonates born at 28 weeks tend to suffer from the disease is greater than in more mature age neonates.

Here are some of the clinical picture shown by the neonate:
  • Aspirate / bilious vomiting.
  • Food intolerance.
  • Bloody stools.
  • Distension and abdominal pain may progress to the stage of perforation with an overview: Abdominal pain increases. Abdominal wall hard and looked pale. Edema of the abdominal wall. Bowel sounds disappear. There are abdominal mass.
  • Sepsis with clinical features: temperature instability. Jaundice. Apnea and bradycardia. Lethargy. À hypoperfusion shock (Lissaueur Tom and Avroy Fanaroff: 86).


Nursing Management for Necrotizing Enterocolitis

Basic principles of nursing management of NEC is planning nursing care in acute abdomen with the threat of septic peritonitis. The aim is to prevent worsening of the disease, intestinal perforation, and shock. If NEC occurs in epidemic group, the patients should be considered for isolation.


1. General Care
Neonates treated in an incubator in a private room with a notice of action aseptic / antiseptic. Monitoring of vital signs carried out continuously, fluid and electrolyte balance properly recorded and performed abdominal x-ray.

2. Rest Intestine
Oral feeding was stopped, decompression of the stomach by placing orogastric tube (evidence level III, level B recommendation). Lavement given when the neonate has not defecation.

3. Nutrition: Parenteral and Enteral.

4. Antibiotics.

5. Acidosis.

6. Disseminated intravascular coagulation
This situation can be suspected when: Low hematocrit. Low platelets. Prothrombin time elongated. Thromboplastin time elongated. Decreased fibrinogen.

7. Surgery.

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