新生儿坏死性小肠结肠炎要点课件

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1、NECROTIZINGENTEROCOLITISGadassiNoaMD.MPH.NEC-Incidence1%-8%ofallNICU’sadmissionsMortalityrate10%-50%Mainlyaffectspreterminfants(90%)~10%interminfantsIncidenceincreasesasgestationalandbirthweightdecreaseNogender,seasonal,socioeconomicassociationNEC-onsetofdiseaseEndemicv

2、ersusepidemicappearanceMediandaysofonsetatterm:2daysMedianageatonset<26weeks:23daysPathophysiologyPrematurityFormulaFeedingBacterialcolonizationIntestinalIschemiaPrematurity90%ofcasesoccurinpreterminfants10%ofbabies<1500grThemorepreterm,thehighertheriskThespecificreason

3、isnotwellundcerstoodImmaturegut:DecreasedmucusproductionDecreasesgastrointestinalhormonesInappropriatecellularandhumoralimmuneresponsetointestinalpathogens(IgA,Neutrophilfunction,Macrophageactivation,cytokineproductionandfunction)DifferentbloodflowautoregulationDecrease

4、dmotilityBacterialcolonizationCytokinesandimmunereceptorsonenterocytesEnteralfeeding90%-95%ofNECcaseswereexposedtoenteralfeedingFeedingthepreterminfant:*Whentostart?*Rate?Cyclingbolusvscontinuous?*Volume?*Typeoffeeding?Formula?*Osmolarity?FactorsinBreastMilkthatmay

5、InfluencePathophysiologyofNECNeonatalantigenspecificantibodies-IgA,IgG,IgMLeukocytesOligosacharidesPolyunsaturatedfattyacidsLactoferrinGlutamineArgininePlateletactivatingfactoracetylhydrolaseEpidermalgrowthfactorIL-10ErythropoietinCopyright©2006AmericanAcademyofPediatri

6、csJesse,N.etal.Neoreviews2006;7:e143-e150AninterrelationshipbetweenlackofenteralfeedingandintestinalintegrityBacterialcolonization/infectionThefetushassterileintestinalinvironmentCommensalmicroflora(bacterialcellswithintheintestine)vs.pathogenicbacteriaNutritionimpacton

7、colonizationpattern:Breastfeeding–LactobacilliandBifidobacteriumFormula-fed–EnterobcteriaceaeEffectofcompositionofintestinalfloraonintestinalhomeostsisandepithelialdevelopmentBacteremiaoccursin~20%-30%casesofNEC(gram+,gram-,anaerobes,viruses..)Hypoxia-ischemiaTermneona

8、tes–conditionsthatcompromisetheintestinalbloodflow:PolycytemiaBirthasphyxiaExchangetransfusionCongenitalheartd