Recurrent Necrotizing Enterocolitis in Late Preterm and Full-Term Babies: A Case Report and Literature Review.

Abstract

Necrotizing enterocolitis (NEC) is a serious inflammatory condition of the intestines that primarily affects premature infants, though it can also occur in full-term infants. Diagnosing and managing recurrent NEC in full-term infants can be particularly challenging, with most requiring surgical intervention upon presentation if medical treatment is insufficient. An approach that emphasizes active medical management while minimizing excessive bowel resection tends to result in better postoperative outcomes, highlighting the need for increased awareness within the healthcare community regarding the complexities of NEC cases. The Security Forces Hospital Program in Riyadh, Saudi Arabia, conducted a study on two cases of necrotizing enterocolitis. The cases involved a full-term baby and a late preterm baby, both of whom had challenging hospital courses and required active care. The study presents a chronological order of the clinical presentation, in-hospital course, and difficulties encountered. The study also includes a brief literature review using PubMed and ProQuest databases. The first case is of a 34+6-week-old baby boy, weighing 2.26 kg at birth, who experienced a normal vaginal delivery but faced complications due to group B Streptococcus. Initially, he showed signs of hypoactivity and a distended abdomen, leading to a diagnosis of sepsis versus necrotizing enterocolitis (NEC). After medical treatment, he was discharged but later returned with worsening symptoms, prompting an ultrasound and subsequent surgery that revealed extensive NEC. Following a stoma procedure and treatment for bowel obstruction, the patient made a full recovery and had a successful stoma closure 10 weeks later. Now, almost four years old, he is thriving and doing well. In the second case, the mother gave birth to a full-term 39 + 2 weeks-old baby boy via normal spontaneous vaginal delivery, weighing 2.51 kg, with no significant antenatal issues. At 10 days old, the baby developed necrotizing enterocolitis (NEC), which was treated before discharge. However, at two months, he was readmitted with sepsis, and an abdominal X-ray showed a thickened bowel loop but no signs of NEC. An ultrasound later indicated ileocolic intussusception, leading to exploratory surgery that revealed NEC and Meckel's diverticulum, but no intussusception was found. The surgery involved creating stomas, and the baby recovered well, with plans for stoma closure 52 days later. He has since been discharged and is making progress in speech therapy after experiencing some delayed speech. Recurrent necrotizing enterocolitis is a rare condition in full-term infants, and its occurrence in de novo cases remains unclear. This condition presents significant challenges in diagnosis and management, potentially leading to long-term gastrointestinal issues or even death, highlighting the importance of prompt diagnosis and appropriate treatment. While medical management is the primary approach, surgical intervention may be required in cases where medical treatment fails, and it is crucial to avoid excessive bowel resection and ensure long-term follow-up for affected infants.