A case of successful treatment of an extremely preterm infant with necrotic enterocolitis complicated by sepsis of bacterial and fungal etiology

Authors

DOI:

https://doi.org/10.14739/2310-1237.2022.1.252134

Keywords:

necrotizing enterocolitis, peritonitis, sepsis, premature infant

Abstract

The aim. To acquaint medical practitioners with the case of successful surgical treatment and intensive care of a extremely preterm infant with necrotic enterocolitis, complicated with intestinal perforation and sepsis of mixed bacterial and fungal etiology.

Materials and methods. The child was treated in the Neonatal Anesthesiology and Intensive Care Department of Communal Non-commercial Enterprise “City Children’s Hospital No. 5” of Zaporizhzhia City Council. Blood analyses, microbiological, X-ray and ultrasound examinations were performed by indications using the hospital equipment.

Results. An extremely preterm, very low birth weight infant underwent nine traumatic surgical interventions for NEC with gastric and intestinal perforation, diffuse peritonitis, and adhesive intestinal obstruction. The child’s condition was complicated by sepsis of mixed bacterial and fungal etiology. Preoperative preparation included antibacterial therapy, infusion therapy with modern balanced polyionic solutions, and inotropic support.

During and after surgical interventions, the child underwent multimodal combined anti-stress anesthesia with the use of neuroaxial blocks, prolonged MLV, antibacterial therapy with modern drugs according to the de-escalation principle and microbiological peculiarities of the department, antifungal therapy with reserve drugs, immune replacement therapy, parenteral nutrition and infusion program using blood products according to indications. Despite the child’s critically severe condition and morphofunctional immaturity, the child has survived, has no neurological deficit, and has gained four times his initial body weight.

Conclusions. The use of multimodal combined anesthesia with caudal-epidural blocks in the intra- and postoperative periods, adequate respiratory and hemodynamic support, parenteral and early enteral feeding in a deeply premature baby with NEC probably contributed to antinociceptive protection and positive treatment outcome after 9 urgent operations. The reserve antibiotics and antifungal drugs prescription according to de-escalation principle, considering the sensitivity of the bacterial flora to them, bacteriological monitoring and immune replacement therapy, had a positive result in the treatment of sepsis, which complicated the course of NEC in the newborn baby.

Author Biographies

M. Yu. Kurochkin, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor of the Department of Pediatric Diseases

A. H. Davydova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pediatric Diseases

M. O. Makarova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pediatric Surgery and Anesthesiology

I. H. Denysenko, Communal Non-commercial Enterprise “City Children’s Hospital No. 5” of Zaporizhzhia City Council

Head of Neonatal Anesthesiology and Intensive Care Unit

Yu. V. Horodkova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Assistant of the Department of Pediatric Diseases

References

Isani, M. A., Delaplain, P. T., Grishin, A., & Ford, H. R. (2018). Evolving understanding of neonatal necrotizing enterocolitis. Current opinion in pediatrics, 30(3), 417-423. https://doi.org/10.1097/MOP.0000000000000629

Heida, F. H., Stolwijk, L., Loos, M. H., van den Ende, S. J., Onland, W., van den Dungen, F. A., Kooi, E. M., Bos, A. F., Hulscher, J. B., & Bakx, R. (2017). Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: Results from three academic referral centers. Journal of pediatric surgery, 52(2), 273-276. https://doi.org/10.1016/j.jpedsurg.2016.11.024

Mavropulo, T. K. (2017). Nekrotyzuiuchyi enterokolit novonarodzhenykh - problemy diahnostyky [Neonatal necrotizing enterocolitis - diagnostic problems]. Neonatology, Surgery and Perinatal Medicine, 7(4), 95-101. [in Ukrainian]. https://doi.org/10.24061/2413-4260.VII.4.26.2017.17

Markel, T. A., Martin, C. A., Chaaban, H., Canvasser, J., Tanner, H., Denchik, H., & Good, M. (2020). New directions in necrotizing enterocolitis with early-stage investigators. Pediatric research, 88(Suppl 1), 35-40. https://doi.org/10.1038/s41390-020-1078-0

Neu, J., & Pammi, M. (2017). Pathogenesis of NEC: Impact of an altered intestinal microbiome. Seminars in perinatology, 41(1), 29-35. https://doi.org/10.1053/j.semperi.2016.09.015

Baranowski, J. R., & Claud, E. C. (2019). Necrotizing Enterocolitis and the Preterm Infant Microbiome. Advances in experimental medicine and biology, 1125, 25-36. https://doi.org/10.1007/5584_2018_313

Ma, Y. P., Ma, J. Y., & Tong, X. M. (2018). [A review of the relationship between gut microbiome and necrotizing enterocolitis in preterm infants]. Chinese journal of contemporary pediatrics, 20(8), 680-685. https://doi.org/10.7499/j.issn.1008-8830.2018.08.015

Wandro, S., Osborne, S., Enriquez, C., Bixby, C., Arrieta, A., & Whiteson, K. (2018). The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis. mSphere, 3(3), e00104-18. https://doi.org/10.1128/mSphere.00104-18

Pammi, M., Cope, J., Tarr, P. I., Warner, B. B., Morrow, A. L., Mai, V., Gregory, K. E., Kroll, J. S., McMurtry, V., Ferris, M. J., Engstrand, L., Lilja, H. E., Hollister, E. B., Versalovic, J., & Neu, J. (2017). Intestinal dysbiosis in preterm infants preceding necrotizing enterocolitis: a systematic review and meta-analysis. Microbiome, 5(1), 31. https://doi.org/10.1186/s40168-017-0248-8

Samuels, N., van de Graaf, R. A., de Jonge, R., Reiss, I., & Vermeulen, M. J. (2017). Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC pediatrics, 17(1), 105. https://doi.org/10.1186/s12887-017-0847-3

Hackam, D., & Caplan, M. (2018). Necrotizing enterocolitis: Pathophysiology from a historical context. Seminars in pediatric surgery, 27(1), 11-18. https://doi.org/10.1053/j.sempedsurg.2017.11.003

Meister, A. L., Doheny, K. K., & Travagli, R. A. (2020). Necrotizing enterocolitis: It's not all in the gut. Experimental biology and medicine, 245(2), 85-95. https://doi.org/10.1177/1535370219891971

Gordon, P. V., Swanson, J. R., MacQueen, B. C., & Christensen, R. D. (2017). A critical question for NEC researchers: Can we create a consensus definition of NEC that facilitates research progress?. Seminars in perinatology, 41(1), 7-14. https://doi.org/10.1053/j.semperi.2016.09.013

Juhl, S. M., Hansen, M. L., Fonnest, G., Gormsen, M., Lambaek, I. D., & Greisen, G. (2017). Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge. Acta paediatrica (Oslo, Norway : 1992), 106(3), 394-398. https://doi.org/10.1111/apa.13541

Eaton, S. (2017). Necrotizing enterocolitis symposium: Epidemiology and early diagnosis. Journal of pediatric surgery, 52(2), 223-225. https://doi.org/10.1016/j.jpedsurg.2016.11.013

Gephart, S. M., Gordon, P. V., Penn, A. H., Gregory, K. E., Swanson, J. R., Maheshwari, A., & Sylvester, K. (2018). Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell's stages and biomarkers for NEC. Seminars in pediatric surgery, 27(1), 3-10. https://doi.org/10.1053/j.sempedsurg.2017.11.002

Robinson, J. R., Rellinger, E. J., Hatch, L. D., Weitkamp, J. H., Speck, K. E., Danko, M., & Blakely, M. L. (2017). Surgical necrotizing enterocolitis. Seminars in perinatology, 41(1), 70-79. https://doi.org/10.1053/j.semperi.2016.09.020

Gilfillan, M., & Bhandari, V. (2017). Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early human development, 105, 25-33. https://doi.org/10.1016/j.earlhumdev.2016.12.002

Vorotyntsev, S. I., Hrynovska, M. B., Sofilkanych, M. M., & Zakharchuk, O. V. (2018). Efficacy of regional analgesia techniques in abdominal surgery patients with obesity. Pathologia, 15(2), 229-235. https://doi.org/10.14739/2310-1237.2018.2.141426

Downloads

Published

2022-04-15

How to Cite

1.
Kurochkin MY, Davydova AH, Makarova MO, Denysenko IH, Horodkova YV. A case of successful treatment of an extremely preterm infant with necrotic enterocolitis complicated by sepsis of bacterial and fungal etiology. Pathologia [Internet]. 2022Apr.15 [cited 2024Apr.16];19(1):84-8. Available from: http://pat.zsmu.edu.ua/article/view/252134

Issue

Section

Case Reports