Images in Clinical Medicine
Neonatal Necrotizing Enterocolitis
N Engl J Med 2001; 344:108January 11, 2001
- Article
Figure 1 A baby required active resuscitation when he was born at 26 weeks of gestation weighing 918 g. The Apgar scores were 2, 3, and 7 at 1, 5, and 10 minutes, respectively. The early neonatal period was complicated by systemic hypotension and respiratory distress syndrome. The infant was given inotropic support, surfactant, and antibiotics. A patent ductus arteriosus was surgically ligated after a trial of indomethacin failed. The infant was intubated and received oxygen for 51 days, and he achieved full enteral feeding on day 26. On day 52 extensive abdominal distention, bilious gastric aspirate, frank blood in the stools, and signs of peritonitis developed. An x-ray film obtained 10 minutes after the onset of this clinical deterioration showed extensive portal-vein gas (arrows), as indicated by the pattern of linear branching lucencies within the liver, and pneumatosis intestinalis (arrowheads), as indicated by the small circular lucencies on the right side of the abdomen. There was marked distention of bowel loops throughout the abdomen with air–fluid levels. Septic shock and disseminated intravascular coagulation soon developed that were unresponsive to treatment, and the infant died 12 hours after the onset of illness.
Husam Salama, M.D.
Orlando da Silva, M.D.
St. Joseph's Health Centre, London, ON N6A 4V2, Canada
