Necrotising Enterocolitis (N)

Question 1

What are the risk factors for NEC?

Answer 1

Prematurity, IUGR, multiple birth
CHD (duct-dependent), PDA
Infection, chorioamnionitis
Abnormal EDF on UA Doppler
Perinatal asphyxia
Exchange transfusion
Formula feeds 
Emperical antibiotics

**Commonest serious acquired disease of GIT in preterm infants occuring most frequently between 7-21 days

Question 2

What are the signs and symptoms of NEC?

Answer 2

• Feed intolerance
• Vomiting (bile stained)
• Diarrhoea, delayed gastric emptying, distended abdomen, tender, decreased bowel sounds, fresh blood in stool
• Apnoea, lethargy, decreased perfusion to peripheries, CV collapse
• Temperature instability, increased desats/bradys or apnoeas
• Unexplained metabolic acidosis (septic shock)

**Classical Triad: Abdo distension, bloody stools, pneumatosis intestinalis (dissection of gas into intestinal wall on X-ray) + bilious aspirates

Question 3

What investigations are carried out for NEC?

Answer 3

FBC, biochemistry, CRP, blood film, blood gas, coagulation screen, G+S
Blood cultures
AXR AP supine

Question 4

What is the management for NEC?

Answer 4

• Prevention : supplement milk feed with pre and probiotics
• Stop oral feed, IV access, escalate consultant
• gastric aspiration, parenteral nutrition
• Antibiotics - Cefotaxime, vancomycin, one stat gentamicin dose
• Pain relief - always start IV morphine IF baby ventilated
• Mechanical ventilation
• IV fluids, TPN (total vol. 120-150ml/kg or less)
• Resus - fluids initially, blood products IF anaemia/TCP/DIC
• Surgery if bowel perforation

Question 5

What are some complications of NEC?

Answer 5

1. Strictures

2. Malabsorption if extensive ressection

Question 6

What is Bell’s staging?

Answer 6

Stage I
Clinical signs 🡪 lethargy, temperature instability, apnoea, low HR, emesis, abdominal distension, haematochezia
Radiographic findings 🡪 intestinal dilation
Treatment 🡪 stop oral feed. Parenteral nutrition. NG suction. Antibiotics (3 days)

Stage IIa
Mildly ill
Antibiotcs 7-10 days

Stage IIb
Clinical signs 🡪 same as stage I, metabolic acidosis, low platelets, abdominal tenderness, absent bowel signs
Radiographic finding 🡪 intestinal dilation, portal venous gas, pneumatosis intestinalis
Treatment 🡪 as stage I + treat metabolic acidosis, antibiotics 14 days

Stage IIIa
Shock
Clinical signs 🡪 as stage II, respiratory or circulatory arrest
Radiographic findings 🡪 as stage II, ascites
Treatment 🡪 as stage II, inotropes

Stage IIIb
Perforation
Radiographic signs 🡪 pneumoperitoneum
Treatment 🡪 surgery