NECROSING GASTROENTEROCOLITIS IN NEWBORN PATIENTS: CLINICAL EVALUATION AND POSSIBLE TREATMENTS

Abstract

Necrotizing gastroenterocolitis (GECN) is a serious inflammatory disease that affects the gastrointestinal tract of newborns, especially premature babies, and can lead to intestinal necrosis and perforation. GECN is a leading cause of neonatal morbidity and mortality, with an estimated incidence of 0.3 to 2.4 cases per 1000 live births and a mortality rate of 15 to 30%. Treatment for GECN depends on the stage of the disease and may include supportive measures, antibiotic therapy, parenteral nutrition and surgery. Objective: to synthesize scientific evidence on the clinical assessment and possible treatments of GECN in newborn patients. Methodology: This review was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The PubMed, Scielo, Web of Science and Cochrane Library databases were consulted, using the following descriptors: “necrotizing enterocolitis”, “neonates”, “diagnosis”, “treatment” and “outcome”. Articles published in the last 10 years (2013-2023), in Portuguese or English, that addressed clinical, diagnostic, therapeutic or prognostic aspects of GECN in newborns were included. Articles that were not original, that did not have sufficient data or that were not relevant to the topic were excluded. The selected articles were evaluated regarding methodological quality, data extraction and analysis of results. Results: 16 articles were selected. The diagnosis of GECN was based on the combination of clinical signs (abdominal distension, bilious vomiting, blood in the stool), laboratory changes (leukocytosis or leukopenia, metabolic acidosis, thrombocytopenia) and radiological findings (intestinal pneumatosis, pneumoperitoneum). Treatment for GECN varied according to the stage of the disease and consisted of supportive measures (fasting, hydration, oxygenation, monitoring), antibiotic therapy (ampicillin, gentamicin, metronidazole), parenteral nutrition and surgery (laparotomy, enterostomy, intestinal resection). The main complications of GECN were intestinal perforation, peritonitis, intestinal stenosis, recurrent enterocolitis, multiple organ failure and death. Conclusion: GECN is a serious disease that mainly affects premature newborns and requires a multidisciplinary approach for its diagnosis, treatment and prevention. Despite advances in understanding the mechanisms involved in GECN, there is still a need for more studies to clarify the clinical, therapeutic and prognostic aspects of the disease. Furthermore, it is important to monitor patients with GECN to identify and treat possible complications and sequelae resulting from the disease.