Necrotizing Enterocolitis (NEC / नेक्रोटाइजिंग एंटरोकॉलिटिस) एक serious gastrointestinal emergency है जो मुख्य रूप से premature और low birth weight infants में होती है।
- यह स्थिति intestinal tissue (आंत) में inflammation और necrosis का कारण बनती है।
- NEC rapidly progress कर सकती है और life-threatening हो सकती है।
- Early detection और intensive care critical है।
Necrotizing Enterocolitis क्या है (What is Necrotizing Enterocolitis)
- Inflammation और tissue death (necrosis) of intestines
- Most commonly affects terminal ileum और proximal colon
- Pathophysiology में शामिल हैं: intestinal immaturity, bacterial colonization, ischemia
- Symptoms vary from mild feeding intolerance to severe sepsis
Necrotizing Enterocolitis कारण (Causes of Necrotizing Enterocolitis)
1. Prematurity and Low Birth Weight
- Immature intestines more susceptible
- Most cases in infants <32 weeks gestation
2. Intestinal Ischemia
- Reduced blood flow leads to necrosis
- Associated with hypotension, shock, or cardiac anomalies
3. Bacterial Colonization
- Abnormal gut flora (E. coli, Klebsiella, Enterobacter)
- Dysbiosis contributes to inflammation
4. Feeding Practices
- Formula feeding vs breast milk (breast milk protective)
- Rapid feeding increments may trigger NEC
5. Other Risk Factors
- Perinatal hypoxia
- Sepsis
- Maternal diabetes or preeclampsia
Necrotizing Enterocolitis लक्षण (Symptoms of Necrotizing Enterocolitis)
- Feeding intolerance, vomiting, abdominal distension
- Bloody stools (hematochezia)
- Lethargy, hypotension, temperature instability
- Apnea or bradycardia in premature infants
- Advanced: abdominal wall erythema, metabolic acidosis, septic shock
Early recognition critical to prevent intestinal perforation and systemic sepsis।
Necrotizing Enterocolitis कैसे पहचाने (Diagnosis of Necrotizing Enterocolitis)
- Clinical Examination – abdominal distension, tenderness, bloody stools
- Laboratory Tests – neutropenia, thrombocytopenia, metabolic acidosis, elevated CRP
- Imaging
- Abdominal X-ray: pneumatosis intestinalis (air in bowel wall)
- Free air in peritoneum indicates intestinal perforation
- Staging (Bell’s criteria) – Stage I–III based on severity
- Monitor vital signs – hypotension, hypothermia, lethargy
Diagnosis is primarily clinical + radiological।
Necrotizing Enterocolitis इलाज (Treatment of Necrotizing Enterocolitis)
1. Medical Management (Mild to Moderate Cases)
- Nil per os (NPO / stop oral feeds)
- Nasogastric decompression
- Broad-spectrum IV antibiotics (ampicillin + gentamicin ± metronidazole)
- IV fluids, electrolytes, nutritional support
- Monitor vital signs and laboratory parameters
2. Surgical Intervention (Severe Cases)
- Indicated for perforation, necrosis, or uncontrolled sepsis
- Procedures: laparotomy, bowel resection, ostomy
- Postoperative intensive care required
3. Supportive Care
- Respiratory support (ventilation if needed)
- Pain management
- Continuous monitoring of fluid and electrolytes
Early intervention reduces mortality and morbidity।
रोकथाम (Prevention)
- Prefer exclusive breast milk feeding
- Slow, carefully monitored feeding advancement
- Use of probiotics in high-risk premature infants (where evidence supports)
- Strict infection control in NICU
- Early detection of feeding intolerance or abdominal distension
सावधानियाँ (Precautions)
- Close monitoring of premature and low birth weight infants
- Avoid rapid increases in feeding volume
- Immediate evaluation of abdominal distension, bloody stools, or lethargy
- Maintain strict hygiene in NICU to prevent infections
FAQs (अक्सर पूछे जाने वाले प्रश्न)
Q1. Necrotizing Enterocolitis कितनी आम है?
Mostly premature infants (<32 weeks) में 5–10% incidence reported।
Q2. क्या यह life-threatening है?
हाँ, severe NEC में mortality rate 20–30% तक हो सकती है।
Q3. क्या NEC recover हो सकता है?
Mild to moderate cases medical management से recover हो सकते हैं। Severe cases में surgery और prolonged NICU care आवश्यक।
Q4. Breast milk कितना protective है?
Breast milk significantly reduces NEC risk due to immune factors और beneficial microbiota।
निष्कर्ष (Conclusion)
Necrotizing Enterocolitis (नेक्रोटाइजिंग एंटरोकॉलिटिस) एक गंभीर gastrointestinal disorder है, जो premature और low birth weight infants को प्रभावित करता है।
Early detection, supportive care, antibiotic therapy और timely surgical intervention से complications और mortality को कम किया जा सकता है।
अगर किसी preterm infant में feeding intolerance, abdominal distension या bloody stools दिखाई दें, तो तुरंत NICU / pediatric specialist से consultation जरूरी है।