Necrotising enterocolitis

Question 1

What is Necrotising enterocolitis and who does it affect?

Answer 1

A life threatening emergency affecting premature neonates where part of the bowel becomes necrotic and may perforate (and lead to peritonitis and shock)

Question 2

Risk factors for NEC

Answer 2

Very low birth weight or very premature
Respiratory distress and assisted ventilation
Sepsis
Formula feeds
PDA, congenital heart disease

Question 3

Presentation of NEC

Answer 3

Intolerance to feeds
Vomiting (particularly bilious)
Generally unwell
Distended, tender abdomen
Absent bowel sounds
Bloody stools

Question 4

Investigations in suspected NEC

Answer 4

FBC - thrombocytopaenia and neutropenia

CRP
VBG - metabolic acidosis picture
Blood culture - for sepsis

Abdominal X-ray is the investigation of choice for diagnosis:

• Dilated loops of bowel
• Bowel wall oedema (thickened bowel walls)
• Gas in the bowel walls
• Pneumoperitoneum - free gas in the peritoneal cavity (this indicates perforation)

Question 5

Management of NEC

Answer 5

NBM
IV fluids
TPN
Antibiotics

NG tube can be inserted to drain fluid and gas from the stomach and intestines

Refer to neonatal surgeons - may need surgical removal of necrotic bowel and temporary stoma

Question 6

Complications of NEC

Answer 6

Perforation and peritonitis
Sepsis
Death

Abscess formation
Strictures
Long term stoma
Short bowel syndrome following surgery