Necrotising Enterocolitis

Question 1

What is necrotising enterocolitis

Answer 1

A condition in which the bowel of premature infants becomes ishaemic and infected

Question 2

What are risk factors for developing necrotising fasciitis

Answer 2

Prematurity
LBW
Non-breast milk feeds
Sepsis
Acute hypoxia
Poor intestinal perfusion

Question 3

How does a neonate present with necrotising fasciitis

Answer 3

presents usually in the first 3 weeks of life
Vomiting - may be green stained
Bloody stools
Abdominal distension
Absent bowel sounds
Signs of systemic compromise including an acidosis on a blood gas

Question 4

Dx of necrotising enterocolitis

Answer 4

Abdominal X-Ray
…which may show:

Dilated bowel loops
Pneumatosis intestinalis (gas within bowel wall)
Portal venous gas
Pneumoperitoneum

Question 5

What is Bells’ classification

Answer 5

To determine stage of NEC

Uses a mix of radiologic and clinical findings

Question 6

What is this

Answer 6

NEC

Question 7

Mx of NEC

Answer 7

Nil-by-mouth, nasogastric tube passed and admitted to neonatal unit

Broad spectrum antibiotics

Total parenteral nutrition (to reset the bowel)

Supportive treatment with IV fluids and ventilation

Surgery to resect necrotic sections may be necessary

SURGERY IS ALWAYS NECESSARY WITH BOWEL PERFORATION

Question 8

Some prevention risks for NEC

Answer 8

Breastfeeding reduces risk

Delayed cord clamping at delivery also reduces risk

Question 9

What broad spectrum Abx do you use

Answer 9

Clindamycin
Cefotaxime

Question 10

What does a pneumoperitoneum indicate

Answer 10

Perforation > NEEDS SURGICAL RESECTION