Prevencija i liječenje nekrotizirajućeg enterokolitisa u novorođenčadi

master's thesis

• Title (english): Prevention and treatment of necrotizing enterocolitis in newborns
• Author: Lucija Bradić
• Mentor: Tomislav Luetić (mentor)
• Committee member: Anko Antabak (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Tomislav Luetić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Nekrotizirajući enterokolitis je gangrenozna upala crijeva karakteristična za neonatalnu dob. Jedna je od najzagonetnijih bolesti kojoj patogeneza nije poznata ali je prihvaćeno da je multifaktorska. Nekrotizirajući enterokolitis ima široki spektar kliničkih manifestacija koji može varirati od tipične slike prostriranog novorođenčeta velikog i napetog trbuha s krvavim stolicama i povraćanjem sadržaja obojenog žući, do slike djeteta koje ima samo povremeni nalaz krvi u stolici, ne podnosi hranu ili zadržava hranu u želucu. Bolest se dijagnosticira na temelju kliničke slike upotpunjene sa radiološkim i laboratorijskim nalazima.
Liječenje može biti konzervativno u smislu nadoknade tekućine, mehaničke ventilacije, dekompresije gastrointestinalnog trakta nazogastričnom sondom, prekida enteralnog hranjenja uz prelazak na potpuno parenteralno hranjenje te primjene antibiotika. Ako se uz konzervativno liječenje postavi indikacija prelazi se na kirurško liječenje. Ovisno o opsežnosti bolesti i stanju bolesnog djeteta primjenjuju se različiti kirurški postupci: resekcije jasno demarkiranog gangrenoznog crijeva sa enterostomijom, resekcije sa anastomozom, a u slučajevima sa nejasnom vitalnošću crijeva ili multifokalnom bolešću dekompresije proksimalnom stomom ili kombinacije kirurških dekompresijsko-drenažnih operacija. Osobitost skupine nedonoščadi vrlo male porođajne težine s nekrotizirajućim enterokolitisom je i mogućnost liječenja primjenom peritonealne drenaže.
Osim liječenja, velika se važnost posvećuje pronalaženju uspješne metode prevencije nekrotizirajućeg enterokolitisa koju se unatoč brojnim istraživanjima danas još uvijek nije pronašlo.

Abstract (english)

Necrotizing enterocolitis is a gangrenous intestinal inflammation characteristic for neonatal age. It is one of the most mysterious diseases with unknown pathogenesis however it is acknowledged as multifactorial. Necrotizing enterocolitis has a broad spectrum of clinical manifestations which may vary from the typical image of a prostrated newborn with a large and taut belly as well as with bloody stools and vomiting content colored bile, or to a picture of a child with a casual finding blood in the stool and that can't stand the food or can't reatin food in the stomach. The disease is diagnosed based on clinical features complemented with radiological and laboratory findings.
Treatment can be conservative such as compensation of fluid, mechanical ventilation, decompression of the gastrointestinal tract with nasogastric tube, interruption of enteral feeding with the transition to a fully parenteral nutrition and the application of antibiotics. In addition to conservative treatment, if there is an indication we proceed to the surgical treatment. Depending on the extent of disease and patient characteristics, a number of different surgical options may be undertaken including resection of clearly demarcated gangrenous bowel with enter ostomy, resection with anastomosis and in situations with marginally viable bowel or multifocal disease decompression with proximal enter ostomy or combination of different decompression and drainage surgical techniques. Especially in group of very small birth weight babies with necrotizing enterocolitis the use of peritoneal drainage could be used as treatment option.
Great importance is paid to finding effective methods of prevention necrotizing enterocolitis that is still not found despite significant scientific efforts.

• Keywords: nekrotizirajući enterokolitis; novorođenče; liječenje; prevencija
• Keywords (english): necrotizing enterocolitis; newborns; treatment; prevention
• Language: croatian
• URN:NBN: urn:nbn:hr:105:007346
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-30 08:18:38