One fullterm infant whose clinical feature initially was that of necrotizing enterocolitis eventually developed intussusception. The symptomatology of these two conditions is strikingly similar, and when they coexist, recognition of a complicating intussusception is difficult. The pathogenic relationship between necrotizing enterocolitis and intussusception remains obscure. When a presumptive diagnosis of necrotizing enterocolitis is made but the infant's clinical course varies from that expected, other diagnoses, such as intussusception, must be considered.
Diagnosis ; Enterocolitis, Necrotizing* ; Humans ; Infant* ; Intussusception*

Hirschsprung's disease (HD) is one of the most common cause of intestinal obstruction in neonates. Enterocolitis is a well known complication of HD. Since a severe form of enterocolitis occurring in HD is the major cause of death and disability of these patients, early diagnosis is essential. Recently, ischemic hemorrhagic necrotizing enterocolitis have been reported as lethal complications of HD. However little distinction is made between inflammatory enterocolitis which often follows HD and hemorrhagic ischemic necrotizing enterocolitis, which is a rare, and often fatal complication of HD. Most of reported cases of hemorrhagic necrotizing enterocolitis developed very early, generally within 3 days of birth except several cases. Which may be confused with necrotizing enterocolitis (NEC) which was not associated with HD. We report here two cases of hemorrhagic necrotizing enterocolitis associated with Hirschsprung's disease, who were initially diagnosed as having NEC.
Cause of Death ; Early Diagnosis ; Enterocolitis ; Enterocolitis, Necrotizing* ; Hirschsprung Disease* ; Humans ; Infant, Newborn ; Intestinal Obstruction ; Parturition

Acute Disease ; Enterocolitis, Necrotizing ; complications ; diagnosis ; Hand, Foot and Mouth Disease ; complications ; diagnosis ; Humans ; Severity of Illness Index

Intussusception in neonates, especially in preterm infants, is rare. Common symptoms of intussusception, which include distended abdomen and gastric residuals, lead to misdiagnosis as necrotizing enterocolitis (NEC). Delayed diagnosis of neonatal intussusception delays treatment as well, which can lead to life-threatening complications. The predominant location of intussusception in preterm neonates is the small bowel; therefore, ultrasonography is not indicated. We report the case of an 834g male baby born at 25 weeks 6 days of gestation, who was diagnosed with double intussusceptions with NEC.
Abdomen ; Delayed Diagnosis ; Diagnostic Errors ; Enterocolitis, Necrotizing* ; Humans ; Infant, Newborn ; Infant, Premature* ; Intussusception* ; Male ; Pregnancy ; Ultrasonography

OBJECTIVE: To study the value of fecal calprotectin (FC) in the diagnosis of neonatal necrotizing enterocolitis (NEC) through a Meta analysis. METHODS: Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Weipu Periodical Database, Wanfang Data, Chinese Biomedical Literature Database were searched for related studies published up to May 2020, with manual search as supplementation. The QUADAS criteria were used to evaluate the quality of the articles included. Meta-DiSc 1.4 and Stata 15.0 software were used to perform the Meta analysis, including the evaluation of specificity, sensitivity, likelihood ratio, and diagnostic odds ratio. The sensitivity analysis and heterogeneity testing were performed, and the summary receiver operating characteristic (SROC) curve and Fagan diagram were plotted. RESULTS: A total of 15 articles were enrolled, involving 1 719 neonates. Among these articles, 4 had low quality, 2 had high quality, and the rest had medium quality. There was high heterogeneity between studies, and there was no threshold effect or publication bias. The random effects model analysis showed that FC had a pooled specificity of 0.80 (95% CONCLUSIONS FC has high potential and efficiency in the early diagnosis of NEC. FC measurement can be used for the diagnosis of NEC, but it should be combined with clinical manifestations and other related laboratory examinations.
China ; Enterocolitis, Necrotizing/diagnosis* ; Feces ; Humans ; Infant, Newborn ; Leukocyte L1 Antigen Complex ; ROC Curve ; Sensitivity and Specificity

Necrotizing enterocolitis (NEC), with the main manifestations of bloody stool, abdominal distension, and vomiting, is one of the leading causes of death in neonates, and early identification and diagnosis are crucial for the prognosis of NEC. The emergence and development of machine learning has provided the potential for early, rapid, and accurate identification of this disease. This article summarizes the algorithms of machine learning recently used in NEC, analyzes the high-risk predictive factors revealed by these algorithms, evaluates the ability and characteristics of machine learning in the etiology, definition, and diagnosis of NEC, and discusses the challenges and prospects for the future application of machine learning in NEC.
Infant, Newborn ; Humans ; Enterocolitis, Necrotizing/therapy* ; Infant, Newborn, Diseases ; Prognosis ; Gastrointestinal Hemorrhage/diagnosis* ; Machine Learning

Neutropenic enterocolitis is an acute life-threatening, necrotizing inflammation of cecum and terminal ileum often seen in leukemia and lymphoma during periods of prolonged or severe neutropenia. It has been also referred to as necrotizing enterocolitis, ileocecal syndrome, or typhlitis (from the Greek word typhlon meaning cecum). The pathophysiology of the neutropenic enterocolitis is unknown but is believed to be multifactorial. The clinical symptoms of neutropenic enterocolitis are nonspecific including fever, abdominal pain (often right lower quadrant), abdominal distension, diarrhea, bloody stools, nausea, and vomiting. So acute appendicitis is should be included in the differential diagnosis. The early signs and symptoms are nonspecific and it may rapidly lead to intestinal perforation. The definite management of neutropenic enterocolitis is contrversial. but the prognosis is likely to be good with early diagnosis and proper management. We report one case of neutropenic enterocolitis in acute myelogenous leukemia with literature review.
Abdominal Pain ; Appendicitis ; Cecum ; Diagnosis, Differential ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enterocolitis, Neutropenic* ; Fever ; Ileum ; Inflammation ; Intestinal Perforation ; Leukemia ; Leukemia, Myeloid, Acute* ; Lymphoma ; Nausea ; Neutropenia ; Prognosis ; Typhlitis ; Vomiting

PURPOSE: The purpose of this study was to examine the usefulness of abdominal sonography in the diagnosis of necrotizing enterocolitis (NEC). METHODS: We reviewed the medical records of 51 neonates who were diagnosed with NEC in the neonatal intensive care unit at Yeouido St. Mary's Hospital of the Catholic University in Korea between January 2008 and December 2012. The neonates underwent abdominal ultrasonography on the day of their diagnosis and on the third day after diagnosis. Simple abdominal radiography was performed on the same day as the sonography. The neonates were diagnosed with NEC in accordance with the abdominal sonographic findings. Abdominal radiography and sonography were used to assess the NEC stages in the neonates. RESULTS: On the day of NEC diagnosis by abdominal sonography, 50 neonates were diagnosed with stage II NEC and 1 was diagnosed with stage III NEC. However, simple radiography diagnosed 49 neonates with stage I NEC, 1 with stage II NEC, and 1 with stage III NEC. On the third day after NEC diagnosis by abdominal sonography, 48 neonates were diagnosed with stage II NEC and 3 were diagnosed with stage III NEC. On the other hand, simple radiography diagnosed 26 neonates with stage I NEC, 24 with stage II NEC, and 1 with stage III NEC. CONCLUSION: Abdominal sonography can be used as a tool for accurately diagnosing NEC and treating neonates showing ambiguous symptoms during the early stages of NEC.
Diagnosis* ; Early Diagnosis ; Enterocolitis, Necrotizing* ; Hand ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Medical Records ; Radiography ; Radiography, Abdominal ; Ultrasonography

Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants' systemic manifestations were mild or absent, and all of them completely recovered within 2-3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC.
Abdomen ; Blood Platelets ; Colitis ; Diagnosis ; Enterocolitis, Necrotizing* ; Gastrointestinal Hemorrhage ; Humans ; Hypersensitivity ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Milk Proteins ; Mortality

OBJECTIVETo study the value of combined measurement of intestinal fatty acid-binding protein (I-FABP) and fecal calprotectin (FC) in the diagnosis of necrotizing enterocolitis (NEC) in full-term neonates.

METHODSA total of 36 full-term neonates with NEC (case group) and 39 neonates without digestive system diseases (control group) were enrolled as study subjects. ELISA was used to measure the serum I-FABP level and fecal FC level, and the clinical value of I-FABP combined with FC in the diagnosis of NEC was evaluated.

RESULTSThe case group had significantly higher I-FABP and FC levels than the control group (P<0.05). In the case group, serum I-FABP level was positively correlated with fecal FC level (r=0.71, P<0.05). In the diagnosis of NEC, I-FABP alone, FC alone, and I-FABP/FC combination had sensitivities of 83.3%, 81.5%, and 79.5%, specificities of 72.5%, 75.8%, and 86.3%, and areas under the ROC curve (AUCs) of 0.82, 0.81, and 0.88. The combined measurement showed significantly higher specificity and AUC than single measurement (P<0.05).

CONCLUSIONSChildren with NEC have significant increases in I-FABP and FC levels, and there is a correlation between them. Combined measurement of I-FABP and FC can increase the specificity of the diagnosis of NEC.

Enterocolitis, Necrotizing ; diagnosis ; Fatty Acid-Binding Proteins ; blood ; Feces ; chemistry ; Female ; Humans ; Infant, Newborn ; Leukocyte L1 Antigen Complex ; analysis ; Male