Nursing care of the child with neutropenic enterocolitis

Neutropenic enterocolitis (NE) is a serious complication in neutropenic patients. Once exclusively thought to be found in patients with leukemia and lymphoma, it is now being seen with increased frequency during bone marrow transplant, chemotherapy for solid tumors, and in patients suffering from acquired immune deficiency syndrome and cyclic neutropenia. The pathophysiology of NE is not completely understood, but unquestionably involves neutropenia, mucosal barrier damage, and infection resulting in a necrotizing process of the bowel wall. The cecum, ileus, and ascending colon are most commonly involved. Initial symptoms are usually nonspecific abdominal pain and fever. Localized, severe right lower quadrant pain, sepsis, and bowel perforation may rapidly develop. Once considered a fatal complication, the outcome for the child with NE has improved with better diagnostic imaging techniques and antibiotics. Most children can be successfully managed conservatively with early introduction of broad-spectrum antibiotics and supportive care. However, a significant number will need surgical intervention. Nursing care of these children requires knowledge of the disease process, excellent clinical assessment skills, and a compassionate, family-centered approach.