Læknablaðið - 15.12.1993, Blaðsíða 19

LÆKNABLAÐIÐ
391
súrefnisskorti við burðarmál og eru farnir að
nærast um munn. Samspil þessara þriggja
orsakaþátta, fyrirburðar, súrefnisskorts við
burðarmál og næringar um munn, virðist vera
það sem mestu máli skiptir í orsakafræði
sjúkdómsins hér á landi. Orsakir eru að
öðru leyti óþekktar og svo virðist sem
þurrmjólkurneysla tengist sjúkdómnum ekkert
sterkar en brjóstamjólkurneysla. Kanna þarf
nánar tengsl sjúkdómsins og aðferða við
fæðugjöf.
Meðferð sjúkdómsins hér á landi hefur
gefið góða raun. Hún er í því fólgin að
gefa breiðvirk sýklalyf í æð í tvær vikur
og hlífa meltingarveginum við fæðu í þrjár
vikur hið minnsta. Meðan á bráðastigi
sjúkdómsins stendur eru skurðaðgerðir
eingöngu framkvæmar á þeim börnum sem
fengið hafa garnarof.
SUMMARY
All cases of neonatal necrotizing enterocolitis
in Iceland in 1976-1991 were reviewed. The
diagnosis was searched for in the records of the
departments of neonatology and pathology. The
records of the 23 cases retrieved were all reviewed
by the authors.
Neonatal necrotizing enterocolitis in Iceland
appeared as five sporadic cases in 1976-1985
and an epidemic of 18 cases in 1987-1990. This
corresponds to an incidence of 0.12% in neonates
in Iceland in the former period and 1 % during the
period of the epidemic. In this group of patients
there were nine boys and 14 girls, with an average
birthweight of 2266 gm (range 530-4286) and a
gestational age of 33.7 weeks (range 24-42). Two
(9%) had severe congenital malformations.
Various pregnancy complications were found,
including maternal preeclampsia, essential
hypertension, diabetes, fever, urinary tract
infection and early rupture of membranes. The
placental histology had been studied in 10 cases,
and 80% of these revealed abnormalities, i.e.
significant degenerative changes, infarcts or acute
inflammation.
The average postnatal age at diagnosis was
8.7 days (range 1-26), 10 days for the five
sporadic cases and 8.3 days during the epidemic.
Conventional risk factors identified included oral
feedings (87%), prematurity (70%), perinatal
hypoxia (61%), acute Cesarean-section (48%),
respiratory distress (43%) and an umbilical
catheterization (43%). The most common clinical
signs in this group of patients were bloody stools
(70%), silent abdomen (57%), vomiting (52%)
and abdominal distention (43%). The X-ray signs
included thick-walled intestines (86%), intestinal
pneumatosis (76%), dilated intestinal loops (71%)
and fluid (52%) or gas (29%) in the peritoneal
cavity. Bacterial cultures, taken from various sites
at diagnosis of the disease in 21 children, revealed
bacterial growth in 15 of the 52 specimens, but
these were considered non-significant and there was
no evidence of lateral spread. The total survival
was 60% in the first 10 years and had improved to
78% in the last six years. Medical treatment only
was successful in 12 of 13 cases. Acute surgical
resection, because of intestinal perforation, was
done in five patients, four of whom survived. Late
surgical resection, because of secondary colonic
stenosis, was done in one patient.
It is concluded that neonatal necrotizing
enterocolitis is a serious disease, affecting
especially neonates that are premature and
have been subjected to perinatal hypoxia. The
interaction of perinatal hypoxia and oral feedings
seems to predispose these babies to the mucosal
damage that initiates the course of events leading to
necrosis of the intestinal wall. The epidemiology
of this disease in Iceland seems similar to that
reported in other studies. Increased awareness has
lead to earlier diagnosis.
HEIMILDIR
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in Folge von Perforation des Ileums. Virch Arch
Pathol 1891; 126: 485-94.
2. Mizrahi A, Barlow O, Berdon W, et al. Necrotizing
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697-706.
3. Black TL, Carr MG, Korones SB. Necrotizing
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Necrotizing enterocolitis in very low birth weight
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Epidemiologic characteristics of necrotizing
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