Necrotising Enterocolitis

Question 1

What is Necrotising Enterocolitis?

Answer 1

• One of the most common neonatal surgical emergencies
• Characterised by variable injury to the intestines, ranging from mucosal damage to necrosis and perforation

Question 2

What is the Epidemiology of Necrotising Enterocolitis?

Answer 2

• 90% of cases occur in preterm infants
• Incidence is reduced in breastfed infants

Question 3

What is the Pathophysiology of NEC?

Answer 3

• Innate Immune Response to the microbiota of the premature infant’s gut leading to inflammation and injury

Question 4

What are the Risk Factors for NEC?

Answer 4

• Prematurity/ very low birth weight
• Formula Feeding
• Exchange transfusion
• Hypoxia

Question 5

What are the Clinical Features of NEC?

Answer 5

• Feeding Intolerance, Vomiting (bile or blood stained), Abdominal Distention and Haematochezia
• As NEC progresses: abdominal tenderness, abdominal oedema, erythema and palpable bowel loops

Question 6

What is the Differential Diagnosis for NEC?

Answer 6

• Neonatal Sepsis
• Hirschsprung disease
• Intestinal Malrotation
• Intestinal Volvulus

Question 7

What Imaging would you do for NEC?

Answer 7

• Plain Abdo Xray: distended bowel loops, thickened bowel wall (bowel oedema), intramural gas (pneumatosis intestinalis), gas in the portal tract and pneumoperitoneum due to bowel perforation

Question 8

What Laboratory tests would you do?

Answer 8

• FBC: Anaemia, Thrombocytopenia and Leukopenia
• U+Es: Hyponatraemia
• Blood Gas: Metabolic Acidosis
• Blood Culture: rule out sepsis

Question 9

How would you stage NEC?

Answer 9

• NEC is staged according to the Bell Scoring System

Question 10

What would you see for Bell’s Stage 1? Clinical Features and Radiological Features?

Answer 10

• Clinical Features: Lethargy, Apnoea, Bradycardia, Emesis, Abdominal Distention and Haematochezia
• Radiological Features: Bowel Distention only

Question 11

What would you see for Bell’s Stage 2? Clinical Features and Radiological Features?

Answer 11

• Clinical Features: Metabolic Acidosis, Thrombocytopenia, abdo tenderness and absent bowel sounds
• Radiological Features: Bowel Distention, Portal Venous Gas, Pneumatosis Intestinalis

Question 12

What would you see for Bell’s Stage 3? Clinical Features and Radiological Features?

Answer 12

• Clinical Features: severe acidosis, electrolyte abnormalities, thrombocytopenia, marked GI bleeding
• Radiological Features: Pneumoperitoneum

Question 13

What are the Prophylaxis options for NEC?

Answer 13

• Prevented by administering antenatal steroids if premature delivery is anticipated
• Breastfeeding is a protective factor
• Probiotics reduce the risk of NEC

Question 14

What is the Medical Management of NEC?

Answer 14

• Withold oral feeds for 10-14 days and replace with Parenteral Nutrition
• IV Abx for 10-14 days
• Systemic Support: Ventilatory support, Fluid Resus, Inotropic support and correction of acid-base balance coagulopathy

Question 15

What is the Surgical Management of NEC?

Answer 15

Surgery should be considered if:
- Intestinal Perforation
- GI obstruction due to strictures
- Deterioration despite medical management

• Most common procedure = intestinal resection with stoma formation

Question 16

What are the Complications of NEC?

Answer 16

• Intestinal Perforation, Sepsis and Death
• Intestinal Stricture and Short Bowel Syndrome