A case of successful treatment of an extremely preterm infant with necrotic enterocolitis complicated by sepsis of bacterial and fungal etiology

Abstract

The aim. To acquaint medical practitioners with the case of successful surgical treatment and intensive care of a extremely preterm infant with necrotic enterocolitis, complicated with intestinal perforation and sepsis of mixed bacterial and fungal etiology. Materials and methods. The child was treated in the Neonatal Anesthesiology and Intensive Care Department of Communal Non-commercial Enterprise “City Children’s Hospital No. 5” of Zaporizhzhia City Council. Blood analyses, microbiological, X-ray and ultrasound examinations were performed by indications using the hospital equipment. Results. An extremely preterm, very low birth weight infant underwent nine traumatic surgical interventions for NEC with gastric and intestinal perforation, diffuse peritonitis, and adhesive intestinal obstruction. The child’s condition was complicated by sepsis of mixed bacterial and fungal etiology. Preoperative preparation included antibacterial therapy, infusion therapy with modern balanced polyionic solutions, and inotropic support. During and after surgical interventions, the child underwent multimodal combined anti-stress anesthesia with the use of neuroaxial blocks, prolonged MLV, antibacterial therapy with modern drugs according to the de-escalation principle and microbiological peculiarities of the department, antifungal therapy with reserve drugs, immune replacement therapy, parenteral nutrition and infusion program using blood products according to indications. Despite the child’s critically severe condition and morphofunctional immaturity, the child has survived, has no neurological deficit, and has gained four times his initial body weight. Conclusions. The use of multimodal combined anesthesia with caudal-epidural blocks in the intra- and postoperative periods, adequate respiratory and hemodynamic support, parenteral and early enteral feeding in a deeply premature baby with NEC probably contributed to antinociceptive protection and positive treatment outcome after 9 urgent operations. The reserve antibiotics and antifungal drugs prescription according to de-escalation principle, considering the sensitivity of the bacterial flora to them, bacteriological monitoring and immune replacement therapy, had a positive result in the treatment of sepsis, which complicated the course of NEC in the newborn baby.

Keywords

• necrotizing enterocolitis
• peritonitis
• sepsis
• premature infant