49. 一個十天大的早產兒，出生後有胎便解出，但在第四天大時陸續開始出現餘奶，這兩天發現有腹脹嘔吐的現象，且嘔吐物為綠色膽汁性。目前體重較出生體重少了15%。腹部x光如圖。以下敘述，何者不正確？
(A)此早產兒患了壞死性腸炎(Necrotizing enterocolitis, NEC)。
(B)應先置放鼻胃管引流，除可減輕腹壓，也可減少吸入性肺炎的發生。另外，必須給予足夠的水分以補充體液的流失。
(C)可以考慮使用Gastrografin診斷及治療。
(D)若確定有腸穿孔，應會診小兒外科醫師考慮手術治療。
(E)可能和cystic fibrosis的患者有相關。

Necrotizing enterocolitis

Clinical features.

Manifestations include abdominal distension, abdominal tenderness, bilious emesis, bloody stools, and abdominal wall erythema.

Cardiovascular compromise can result in metabolic acidosis and oliguria.

In severe cases, NEC may progress rapidly and lead to thrombocytopenia, disseminated intravascular coagulation, and death.

Meconium plug may occur not only in infants with cystic fibrosis or Hirschsprung disease but also in normal infants.

***Meconium ileus is obstruction of the distal ileum caused by inspissated (thickened and dried) meconium, secondary to deficiency of pancreatic enzymes. 

Cystic fibrosis新生兒常見症狀

a. 症狀: abdominal distension, lack of meconium passage, vomiting, and bowel perforation.

b. 診斷: abdominal radiographs that reveal intestinal distension with minimal air–fluid levels. Air remains trapped in the meconium------>no definite air–fluid interface.

Fine gas bubbles may be seen mixed within meconium, producing a characteristic soap-bubble appearance.

c. 治療 an enema that may relieve the obstruction, and surgery for persistent obstruction and resection of injured bowel in cases with perforation.

Early diagnosis and treatment are ixmportant to avoid intestinal perforation, meconium peritonitis, and volvulus.