The Role of Nurses in the Treatment of Necrotizing Enterocolitis in Premature Infants

Abstract

The development of sophisticated technology and therapeutic advances in neonatal intensive care units have combined to decrease the mortality rate of premature infants, but neonatal morbidity has not diminished significantly. Premature infants continue to be at high risk of complications during hospitalization. Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease occurring in premature infants. NEC is an inflammatory bowel disease with significant morbidity and mortality in premature infants. Several unresolved issues, including its unproven pathogenesis, inadequate and often difficult treatment options and the lack of a commonly agreed upon and effective prevention strategy, make this disease an enigmatic clinical entity. With a prevalence of 7-14% in very low birth weight infants (500-1,500 g) and a fatality rate approaching 20-50%, NEC is a significant clinical problem. The treatment of NEC in premature infants can be divided into two categories, medical and surgical, and the choice depends on the stage of the disease. Medical management of NEC is directed at preventing further injury to the bowel. Surgical intervention is indicated when the bowel has perforated, when there is evidence of bowel necrosis or when the infant’s condition worsens despite consistent medical management. Neonatal nurses can reduce the morbidity and mortality attributed to NEC through early detection of the disease and supportive care after its diagnosis. Nurses are thus in the forefront of the effective prevention and treatment of NEC. Close monitoring by nurses and prompt application of nursing interventions can have a profound effect on the outcome by contributing to the stability of the premature infants’ medical condition and acting before NEC progresses to a more serious level.