Chapter 19: Necrotizing Enterocolitis (Newborn)

Question 1

Necrotizing Enterocolitis (NEC)

Answer 1

-mostly affects preterm newborns
-caused by ischemic episode of the bowel
>when a lack of oxygen occurs in any human, blood is shunted from the nonessential organs (e.g. bowel) to the essential organs (lungs and brain)
-if the ischemic attack is severe, it can decrease the circulation to the bowel to the point of ischemia; extent of the portion of the bowel that is affected is dependent on the severity of the ischemia
>once the bowel is necrotic or tissue dies from lack of O2 there is no peristalsis to move food or gas and it builds up in that section of the bowel
>NEC can easily produce septicemia in the preterm newborn

Question 2

Signs and Symptoms of NEC

Answer 2

• lack of bowel movements
• emesis
• pre-feeding aspirates
• abdominal distention
• increase of 1 to 2 cm in abdominal circumference from the last feed
• irritability
• lethargy
• observable loops of bowel (late symptom)

Question 3

Diagnosis

Answer 3

via x-ray exam when a sausage-shaped dilation of the intestine is present

• a dangerous sign= free air in the abdomen that may indicate perforation of the bowel
• lab findings show leukopenia, metabolic acidosis, anemia, electrolyte imbalance, and leukocytosis

Question 4

Prevention

Answer 4

-keeps oxygen saturation levels at acceptable values an decreases excessive environmental stress
>hypoxemia and environmental stress cause blood to be shunted away from the bowel and to the heart and brain

Question 5

Nursing Care

Answer 5

enteral feedings stopped immediately

-physician or neonatal nurse is notified

Question 6

Caring for a Child recovering from NEC

Answer 6

nurse measures and record abdominal circumferences, auscultates bowel sounds before every feeding, and observe for abdominal distention (observable loops or shiny skin indicating distention)
-before any gastric tube feeding, the nurse must check aspirates for undigested formula or breast milk; if excessive (20%) undigested breast milk or formula is found, the nurse must follow hospital protocol, which may suggest the next feeding be held and the physician or neonatal nurse practitioner notified
-all bowel movements are recorded: amount, consistency, and frequency
>hematesting stools detects occult (non-visible) fecal blood

Question 7

Medical Care

Answer 7

initial course with stage I or II NEC includes:
-NPO status for 2 to 14 days
-nasogastric decompression of the abdomen
-broad-spectrum antibiotics
>IV fluids are provided, including TPN and lipids
>stage III should have surgical consultation

Question 8

Surgical Care

Answer 8

if only a small portion of the bowel is affected, a rest period may reinstate enough circulation for future functioning
>if large section of bowel is affected, a surgical bowel resection is warranted, and sometimes it can lead to an ostomy (or ostomies) that may or may not be permanent

Question 9

Education/ Discharge Teaching

Answer 9

• parents are taught about the condition and all the interventions being completed to avoid complications (e.g. gavage feedings and special formulas such as Pregestimil) and promote long-term health for the infant
• taught about ostomy care