The management of NEC includes the discontinuation of enteral feedings, gastrointestinal decompression with nasogastric suction, fluid and electrolyte replacement, total parenteralnutrition, and systemic broad-spectrum antibiotics. When thediagnosis of NEC is made, consultation with a pediatric surgeon should be obtained. Even with aggressive and appropriate medical management, 25% to 50% of infants with NEC requiresurgical intervention. The decision to perform surgery is obvious when the presence of a pneumoperitoneum is observed onabdominal radiograph. Other, not so obvious indications forsurgical intervention include rapid clinical deterioration despitemedical therapy, rapid onset and progression of pneumatosis,abdominal mass, and intestinal obstruction. The surgical procedure of choice is laparotomy with removal of the franklynecrotic and nonviable bowel. Many extremely small infants aremanaged initially with primary peritoneal drainage followed bysurgical intervention as needed later, when the infant is stableand a laparotomy can be performed safely. The long-term outcome includes intestinal strictures requiring further surgicalintervention, short bowel syndrome with poor absorption ofenteral fluids and nutrients, associated cholestasis with resultant cirrhosis and liver failure from prolonged parenteral nutrition,and neurodevelopmental delay from prolonged hospitalization.
HYPOXIC-ISCHEMIC ENCEPHALOPATHY, INTRACRANIAL HEMORRHAGE, AND SEIZURES
The human newborn spends more time asleep (predominantly in rapid eye movement or active sleep) than in a wakeful state and is totally dependent on adults. Primitive reflexes, such as the Moro, grasp, stepping, rooting, sucking, and crossed extensor reflexes, are readily elicited and are normal for this age. In addition, the newborn has a wealth of cortical functions that are less easily shown (e.g., the ability to extinguish repetitive or painful stimuli). The newborn also has the capacity for attentive eye fixation and differential responses to the mother’s voice. During the perinatal period, many pathophysiologic mechanisms can adversely and permanently affect the developing brain, including prenatal events, such as hypoxia, ischemia, infections, inflammation, malformations, maternal drugs, and coagulation disorders, as well as postnatal events, such as birth trauma, hypoxia-ischemia, inborn errors of metabolism, hypoglycemia, hypothyroidism, hyperthyroidism, polycythemia, hemorrhage, and meningitis.
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Focal clonic Repetitive, rhythmic contractions of muscle groups of the limbs, face, or trunk May be unilateral or multifocal May appear synchronously or asynchronously in various body regions Cannot be suppressed by restraint
Focal tonic Sustained posturing of single limbs
Sustained asymmetric posturing of the trunk
Myoclonic Arrhythmic contractions of muscle groups of the limbs, face, or trunk Typically not repetitive or may recur at a slow rate May be generalized, focal, or fragmentary May be provoked by stimulation
Generalized tonic Sustained symmetric posturing of limbs, trunk, and neck May be flexor, extensor, or mixed extensor/flexor May be provoked by stimulation May be suppressed by restraint or repositioning
Orobuccolingual movements Sucking, chewing, tongue protrusions May be provoked by stimulation
Progression movements Rowing or swimming movements of the arms
Pedaling or bicycling movements of the legs
From Mizrahi EM: Neonatal seizures. In Shinnar S, Branski D, editors: Pediatric and adolescent medicine, vol 6, Childhood seizures, Basel, 1995, S. Karger.