Necrotising enterocolitis

Question 1

What is Necrotising enterocolitis?

Answer 1

NEC is an acute inflammatory disease, predominantly affecting preterm infants. It can lead to bowel necrosis, multi-system organ failure and is life-threatening. Prompt recognition of NEC and appropriate treatment is vital

Question 2

What is the mortality rate of necrotising enterocolitis?

Answer 2

50%

Question 3

What is the most common complication of necrotising enterocolitis?

Answer 3

Bowel perforation

Question 4

Why is that necrotising enterocolitis almost exclusively affects neonates?

Answer 4

neonates have immature GI tracts, permitting for overwhelming infection

Question 5

Give 3 risk factors for necrotising enterocolitis in neonates:

Answer 5

1) prematurity
2) low birth weight
3) formula feeding (particularly high osmotic strength formula)

Question 6

Give 6 symptoms associated with necrotising enterocolitis (note that the presentation is highly variable and non-specific):

Answer 6

1. decreased appetite
2. Decreased activity and fatigue
3. Vomiting
4. Diarrhoea
5. Abdominal distension
6. Blood in stool

Question 7

What signs may be seen in severe cases of necrotising enterocolitis?

Answer 7

1) respiratory failure
2) circulatory collapse (cyanosis, irresponsiveness)

Question 8

How is necrotising enterocolitis diagnosed?

Answer 8

abdominal X-ray (anterior, posterior and lateral view)

Question 9

Give 3 X-ray signs that indicate necrotising enterocolitis:

Answer 9

1) dilated loops of bowel
2) pneumatosis intestinalis (gas in the bowel wall)
3) free air in the bowel wall (indicates perforation)

Question 10

Give the four steps of treatment for necrotising enterocolitis:

Answer 10

1) resuscitation of vital signs (ABCDE)
2) stop all feeding - give NG tube to decompress dilated bowels and commence total parenteral feeding
3) commence broad spectrum IV antibiotics
4) laparotomy (surgery) if the condition worsens or bowel perforates

Question 11

What are the common three antibiotics given simultaneously to treat necrotising enterocolitis?

Answer 11

1) ampicillin
2) gentamicin
3) clindamycin/ metronidazole

Question 12

What are 5 other risk factors asides from premature births?

Answer 12

1. Abnormal dopplers (measuring blood flow from the placenta to the baby)
2. Antibiotic courses lasting longer than 10 days or multiple courses of antibiotics
3. Enteral feeding
4. Use of cow’s milk formula
5. Congenital heart disease

Question 13

What are the typical clinical findings of necrotising enterocolitis?

Answer 13

Abdominal distension, tender to palpation and can feel tense or “wooden”
Reduced bowel sounds
Palpable abdominal mass
Visible intestinal loops
Signs of sepsis (e.g. lethargy, temperature instability, haemodynamic instability)

Question 14

What are 4 general complications of NEC?

Answer 14

1. Bowel perforation
2. Disseminated intravascular coagulation
3. Sepsis
4. Adverse neurodevelopmental outcomes (especially in infants who undergo surgery)