[size=20px]An 850 gram infant is receiving medical therapy for necrotizing enterocolitis(NEC). The most reasonable strategy to reduce the likelihood of neurodevelopmental impairment is:

 

A Whole body cooling to 33-34 degrees Celsius

 

B Avoiding an intestinal anastomosis if bowel resection is necessary

 

C Placing a peritoneal drain if pneumoperitoneum occurs

 

D Holding feeds for at least 14 days

 

E Proceeding quickly to laparotomy if there is clinical deterioration[/size]

Edited March 10, 20242 yr by Admin

E

E, we have to look for omphalitis

E

E

E

Correct answer

E Proceeding quickly to laparotomy if there is clinical deterioration

 

Experimental and clinical evidence suggests that NEC results in cognitive impairment that is proportional to the extent of disease and the duration of CNS exposure to mediators released by involved intestine. Therefore, while some surgeons may not intervene until there is pneumoperitoneum or severe physiological compromise, earlier laparotomy and resection may improve neurodevelopmental outcomes. Peritoneal drainage may improve cardiorespiratory function temporarily but does not address the source of neurotoxic mediators. Longer periods of holding enteral feeds after NEC has also been associated with poorer neurodevelopmental outcomes. Enterostomy after bowel resection is not protective and, in one study, was associated with worse cognitive outcomes than primary anastomosis. Finally, there is no known neuroprotective role for hypothermia in infants with NEC.