Necrotising Enterocolitis - NEC

Question 1

What is NEC?

Answer 1

A disorder affecting premature neonates when part of the bowel becomes necrotic

This injury can lead to a immature gut

Question 2

What are the risk factors for NEC?

Answer 2

Prematurity

Low birth weight

Formula feeds rather than breast milk

Question 3

Clinic signs and symptoms of NEC?

Answer 3

Feeding intolerance

Abdominal distension

Bloody stools

Vomiting with green bile

Perforation = peritonitis sx +/- shock + infective sx

Question 4

How to investigate for NEC?

Answer 4

AXR : dilated bowel loops, bowel wall oedema
pneumatosis intestinalis, pneumoperitoneum if perforated - rigler sign)

Bloods : FBC (thrombocytopenia, neutropenia), CRP , CBG (metabolic acidosis), blood culture

Question 5

What may be seen on abdominal X-ray for NEC?

Answer 5

Abdominal X-Ray → dilated bowel loops

bowel wall oedema

pneumatosis intestinalis (intramural gas)

pneumoperitoneum (if perforation - may be associated with Rigler sign).

Question 6

How to medically manage NEC?

Answer 6

NBM + IV fluids
TPN (bowel rest)

Broad spectrum abx :
-> cefotaxmine / tazocin + Vancomycin

NG tube may be used to drain fluid and gas from stomach and intestines

Question 7

How to manage NEC surgically?

Answer 7

Surgical → if perforation or failure to respond to medical treatment.

Laparotomy with resection of necrosed bowel.

Question 8

Complications of NEC long term?

Answer 8

Short bowel syndrome
Stricture development
Neurodevelopmental delays

Question 9

What staging system is used to decide management?

Answer 9

Bell staging

Question 10

What is a common question stem / presenting complaint for this condition?

Answer 10

a 2 week old neonate, born at 34 weeks starts vomiting green fluid and develops bloody stools