Necrotising enterocolitis

Question 1

Necrotising enterocolitis

Answer 1

Disorder affecting premature neonates

Part of bowel becomes necrotic

Life threatening emergency

Question 2

Complications

Answer 2

Perforation

Peritonitis

Shock

Strictures

Abscess formation

Recurrence

Long term stoma

Short bowel syndrome after surgery

Question 3

Risk factors

Answer 3

Very low birth rate or very premature

Formula feeds

Respiratory distress and assisted ventilation

Sepsis

Patent ductus arteriosus and other congenital heart disease

Question 4

Presentation

Answer 4

Intolerance to feeds

Vomiting, particularly with green bile

Generally unwell

Distended, tender abdomen

Absent bowel sounds

Blood in stools

Question 5

Blood tests

Answer 5

FBC- thrombocytopenia and neutropenia

CRP- for inflammation

Capillary blood gas- metabolic acidosis

Blood culture- for sepsis

Question 6

Imaging

Answer 6

Abdo xray investigation of choice
- dilated loops of bowel
- bowel wall oedema
- pneumonitis intestinalis
- pneuperitoneum
- gas in portal veins

Question 7

Management

Answer 7

NBM

IV fluids

Total parenteral nutrition

Antibiotics

Surgery to remove dead bowel (may be left with temporary stoma)