From the Guidelines
Clostridium perfringens necrotizing enterocolitis (NEC) is characterized by signs such as abdominal distension, bloody stools, and bilious emesis, which require immediate attention to prevent high mortality rates. The presentation of NEC involves increased episodes of apnea and bradycardia followed by abdominal distension, bloody stools, and bilious emesis 1. Other signs may include portal venous gas, a focally erythematous abdomen, and signs of sepsis like thrombocytopenia and neutropenia, as well as acidosis in cases of bowel ischemia 1.
Key Signs and Symptoms
- Abdominal distension
- Bloody stools
- Bilious emesis
- Apnea and bradycardia
- Portal venous gas
- Focal abdominal erythema
- Signs of sepsis (thrombocytopenia, neutropenia)
- Acidosis (in cases of bowel ischemia)
The condition is particularly severe when it involves the entire bowel, occurring in about 25% of cases, and is associated with a high mortality rate of 40%–90% 1. Nonoperative management of NEC is successful about 70% of the time, but the decision to operate or use peritoneal drainage depends on the severity of the condition and the presence of bowel perforation 1.
Management Considerations
- Nonoperative management success rate: about 70% of the time
- Operative management: bowel resection with creation of stomas or reanastomosis
- Peritoneal drainage: may be used instead of immediate operation in very low birth weight neonates with bowel perforation
- Antibiotic administration: crucial in the management of NEC, with broad-spectrum empiric therapy appropriate for children with clinical or imaging evidence of perforation and peritonitis 1
From the Research
Signs of Clostridium perfringens Necrotizing Enterocolitis
- The onset of disease is earlier in life, with a more severe clinical course and a larger extent of gangrene 2
- Portal venous gas is highly suggestive for the diagnosis of Cp infection, evident in 77% of all Cp cases 2
- Mortality rate is higher in Cp group, at 44%, compared to 18.7% in the control group 2
- Type A Clostridium perfringens is commonly identified, with alpha toxin production proven in each isolate, but without correlation to the severity of the clinical course, extent of intestinal gangrene, or mortality 2
- Necrotizing enterocolitis associated with Clostridium perfringens type A can occur in previously healthy adults, with symptoms including small bowel and colon involvement, portal or mesenteric vein thrombosis, and high mortality rate 3
Key Factors
- Alpha toxin production by Clostridium perfringens is a key virulence factor, but its concentration does not correlate with the severity of the disease 2, 4
- Non-toxin factors, such as degradative enzymes like sialidases, can promote toxin action and enhance C. perfringens intestinal colonization 4
- Intestinal microbial composition may play a key role in determining which infants are predisposed to NEC, and dysbiosis in preterm infants can contribute to the pathogenesis of NEC 5