The Early Signs and Symptoms of Necrotizing Enterocolitis in Neonate - Research Paper Example

? The Early Signs and Symptoms of Necrotizing Enterocolitis in Neonate Aim. The aim of this paper is to present, to discuss, and to review the different researches and studies that are related to the early signs and symptoms of necrotizing enterocolitis (NEC) in neonates which is known to affect and cause the mortality of significant number of infants. Background. The state of the clinical practice and the detrimental effects of the disease on neonates are included in the main reasons for the need to review different empirical studies that are related to necrotizing enterocolitis specifically the early signs and symptoms. Integrative review is considered as the most appropriate for the research undertaken because it can present a holistic and encompassing view of the disease. Discussion. Through the integrative review conducted, different issues related to the signs and symptoms of necrotizing enterocolitis came into focus. Parameters in the different articles such as the gestational age of the neonate, the feeding start, the onset of signs and symptoms of NEC, the interventions and the management method for the condition, and the outcome of the neonate were given attention. In addition, the strengths and limitations of each research process had also been identified. Early Signs and Symptoms of Necrotizing Enterocolitis in Neonate Introduction Necrotizing enterocolitis (NEC) is defined as a disease that can be acquired by preterm or sick neonates described to have mucosal or even deeper intestinal necrosis (Merck, 2007). The condition is considered as the most common cause of gastro intestinal medical or surgical emergency in neonates affecting approximately 10 percent of the infants with the weight of less than 1500 g. The vague etiology of the disease is related to the rate of mortality which is 50 percent mortality depending on the severity of the case (Springer and Rosenkrantz, 2011). Background of the Study Based on empirical evidences, NEC affects 2 to 5 percent of the total preterm infants. Majority of the cases occurs in less than 36 weeks of the gestational age. In addition, there are different risk factors that are related to the disease based on records such as history of hypoxia, asphyxia and the introduction of enteral feeding. Another condition which can increase the risk of NEC based on different studies is cyanotic heart disease (Puri and Hollwarth, 2009, p.435). In addition to the said risk factors, the presence of the 3 intestinal factors such as preceding ischemic insult, bacterial colonization, and intraluminal substrate can also contribute to the prevalence of NEC (Merck, 2007). For the purpose of the study, such risk factors and related parameters were considered as the focal points of the study undertaken. The said factors were considered as early indications of the possible onset of the disease. Other factors such as geographical origin, ethnicity or gender have no proven effects on the prevalence and occurrence of NEC (Puri and Hollwarth, 2009, p.435). Determining, presenting, and discussing the early onset of NEC is important for possible prevention of the fatal effects of the disease. The study was able to achieve its objectives based on chosen empirical and primary researches focused on the early signs and symptoms of necrotizing enterocolitis. The determination of the onset of the disease can be considered as the most important method to lessen mortality and to resolve the problem on the lack of effective treatment to NEC. Study Design and Data Sources The primary phase in the integrative review of the early signs and symptoms of NEC is the search for data sources which will be included in the study. Different databases such as CINAHL, EBSCOHost and PubMed were used to find five journal articles that explored NEC in different perspectives and with a focus on the diagnosis and clinical signs and symptoms of the disease. In the search for the data sources, there are factors considered for inclusion and exclusion of journal articles. Primarily, the search in the different databases were undertaken through the use of key words which included necrotizing enterocolitis in neonates, signs and symptoms of necrotizing enterocolitis in neonates, and symptoms of necrotizing enterocolitis in neonates. One of the inclusion criteria is the publication date which included articles that are not older than 5 years, thus, covering 2006 to 2011. Another criterion for choosing journal articles is the focus on the determination of early signs and symptoms of NEC. Due to the limited number of articles that concentrated on the specific area, studies that discussed related topics such as the methods of diagnosis, the clinical indications, and the risk factors are then considered. Exclusion criteria include date of publication and language. Journal articles that fall outside the date range were not included in the study. In addition, articles written in non-English languages had been excluded in the study. The subsequent step to choosing the journal articles included is the analysis and discussion of the different parts of each study that can be considered pertinent to the integrative review on the signs and symptoms of NEC. The main phases in the said step are data evaluation, data analysis and presentation. Data evaluation determines the type of research method, parameters, and paradigms had been used and the effects on the results of the study. Each article is examined and the researches with empirical and primary data results had been included in the study. Data analysis is considered as the step for examining and dissecting the articles in a manner that comparative analysis of the different components and parts can be done. Results In the research conducted, five researches had been chosen based on the criteria and the relevance to the topic. The Included Studies One of the studies included in the review was the research of Ng and colleagues which was about the host-response biomarkers for diagnosis of late-onset septicemia and necrotizing enterocolitis in preterm infants. The study was motivated by the high level of difficulty in the diagnosis and detection of the diseases such as NEC. This was accomplished through the case-control study of the biomarkers in 77 sepsis/NEC and 77 nonsepsis cases in the plasma samples. The study concluded that biomarkers, such as ApoSAA which was used in the study, are effective early indicators of NEC. In addition, the method was considered as an accurate method of detecting NEC and late-onset septicemia (Ng et al., 2010). Based on the procedure undertaken through the course of the study, it had presented a strong conclusion and an important contribution to the field of medicine. Another study included was by Panigrahi (2006) which was focused on the practical guide to the prevention and management of NEC. The main reason for the study was to eliminate the second most common cause of morbidity in premature infants which had not improved through the years regardless of the continuously improving medical methods and technology. Based on the study, the early detection of NEC can make a great difference in the health of neonates. There were different points presented in the study that can be considered related to the research on the signs and symptoms of NEC. One was the focus on low birth-weight infants which was a recognized risk factor on the basis of increased susceptibility to NEC. Radiographic determination of indications of pneumatosis intestinalis was the primary method of confirming the presence of NEC (Panigrahi, 2006). Dittmar and colleagues’ study focused on the cases of NEC with Clostridium perfringens (Cp) which was another type of condition that can affect the neonate. In the study, the diagnosis, clinical course, and the role of alpha toxin were the main topics. The study focused on the children which had been diagnosed with NEC to be able to determine the percentage that was affected by Cp. The importance of the study was related to the fact that Cp cases associated with NEC had earlier onset in life, more severe clinical course, and larger extent of gangrene. Thus, it was considered as the more serious type of NEC, detection of which was essential to the patient (Dittmar et al., 2008). Another journal article that had been included in the study explored the interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates. Najaf and colleagues (2010) based their research on the data of patients admitted in hospitals specifically NICU during the period between 2004 and 2008. Different records were included specifically the standard care, the clinical and the radiology records, and bowel perforation. The focus of the said study was important in the specific determination of the status of the neonate through the supervision of the different stages and progression of the disease. The study concluded that the bowel perforation occurs at a median interval of 1 day after the clinical presentation of NEC. This was an important contribution to the monitoring and the deeper understanding of the disease which can ultimately lead to the decrease in the rate of mortality (Najaf et al., 2010). The study by Hunter, Podd, Ford and Camerini (2008) was also included in the review. It was focused on the different neonatal practices related to necrotizing enterocolitis which included both the evidence-based and experience-based data. The study was an assimilation of the different data related to NEC with the aim of educating the ways to manage and determine methods to easily identify the condition. NEC was a disease caused by the interaction of multiple factors which ultimately lead to fatal state of health due to intestinal epithelium damage and invasion of pathogens. The study concluded on the possible important role of the probiotic bacteria in building the defense of the neonate’s body against pathogens (Hunter, Podd, Ford and Camerini, 2008). Analysis of the Articles The 5 journal articles had been compared on the basis of parameters such as the gestational age of the neonate, the onset of feeding, the onset of observable signs and symptoms of NEC, the interventions applied, and the outcome of the neonate (Table 1). Table 1. The comparative analysis of the 5 articles on NEC. Research Parameters . Details Gestational Age Onset Signs/Interventions/Outcome (week) Ng et al. set 1. sepsis/NEC group Signs: (2010) n=37 Average age = 31 41.5 days - the study included patients with Set 2. non-sepsis evident risk or signs and Average age = 328 33 days symptoms of sepsis or NEC Interventions: 1. high-risk group for sepsis/NEC (> 0.199 ApoSAA score) - treated with antibiotics 2. medium-risk (0.099-0.199) - treated with antibiotics 3. low-risk ( Read More