NEC

Question 1

RFs

Answer 1

Prematurity
Low birth weight or growth restric
Reduced perfusion eg placental insuff
Ventilation requirement after birth
PDA (swings BP)
?abx over 10d

Question 2

Mx

Answer 2

Abx
Surgical resection, risk short gut synd
maybe TPN

Question 3

Assoc disorders

Answer 3

Perinatal asphyxia
Polycythemia
Resp distress
Congenital anomalies (meningocoele, CHD)
Cow milk prot induced enterocolitis
G6PD defic

Question 4

Causes and physiol

Answer 4

Vascular, mucosal, toxic injury to immature gut
Maybe genetic facs
Possible link to infec
Does not occur in utero
Hyperactive inflamm in infants due to inadeq or alt colonisat of gut

Question 5

px

Answer 5

Usually in preterms in first 2wk of life
Feeding difficulties
Bloody mucoid stool and bilious vom
Abdo distension with increasing gastric aspirates
Abdo pain
Malaise
Visible intestinal loops
Alt stool pattern
Decr bowel sounds with eryhthema of abdo
Palpable abdo mass or ascites
Assoc bradyc, lethargy, shock, apnoea, resp distress, temp instabil

Question 6

diffs

Answer 6

Sepsis
Haemolytic dis of newborn
Swallowed maternal blood
Volvulus/malrotation
Intussusception
Pseudomem colitis
Stress ulcer
Meconium ileus
Metab or resp acidosis
Apnoea of prematurity
Bacteraemia
Candidiasis
Coarctation of aorta
Enteroviral infec
GORD
Hirchprungs
HA infec
HLHS
Omphalitis
Bact meningitis
UTI
Int perforation

Question 7

ix

Answer 7

Bloods incl clotting
ABG
CRP
AXR- wall thickening, persis gas filled loops, overall gaseous extension
USS- portal air, walled off perf, ascites
New biomarkers

Question 8

Stages

Answer 8

I- suspected
IIA- definite and mild
IIB- definite and mod
IIIA- advanced
IIIB- advanced plus signs of perf

Question 9

mx

Answer 9

NBM and bowel rest
NG or OG for decomp
Fluids, TPN and IV abx for 10days-
Ampicillin/gent or cefotaxime. Plus metronidazole or clind.
Consider antifungals if LT abx hx and not resp to abx.
UGI small bowel follow through surgery if obstruc devs.
Paracentesis for ascites
Tx shock, DIC etc. Eg vasopressors eg naloxone, dop.
Surg if deter or perf/necrosed
Peritoneal drainage
Intub and ventil if apnoea

Question 10

Complics

Answer 10

Perforation
Short bowel synd after surgery
Stoma complics
DIC
Sepsis and shock
Strictures
Fistulae
Abcess
Recurrent NEC