Neonatology - Necrotising Enterocolitis Flashcards
Who is affected by necrotising enterocolitis?
Premature neonates
Why is necrotising enterocolitis an emergency?
Death of the bowel can lead to bowel perforation
Leading to peritonitis and shock
What are the risk factors for developing NEC?
- Very low birth weight or very premature
- Formula feeds
- Respiratory distress and assisted ventilation
- Sepsis
- PDA and other congenital heart diseases
How does NEC present?
- Intolerance to feeds
- Vomiting, green with bile
- Generally unwell
- Distended, tender abdomen
- Absent bowel sounds
- Blood in stools
What happens when bowel perforation occurs in NEC?
Peritonitis and shock
What investigations are used for NEC?
FBC - thrombocytopenia and neutropenia
CRP
Capillary blood gas - metabolic acidosis
Blood culture - sepsis
Abdominal Xray
What is the investigation of choice for diagnosing NEC?
Abdominal xray
Done in supine position
Lateral (from side with patient on their back)
Lateral decubitus ( from side with neonate on their side)
What do abdominal x-rays show in NEC?
Dilated loops of bowel
Bowel wall oedema
Pneumatosis intestinalis
Pneumoperitoneum (from perforation)
Gas in portal veins
What does pneumatosis intestinalis indicate?
Gas in bowel wall
Sign of NEC
How is NEC managed?
Surgical emergency
Immediate neonatal surgical referral
- In suspected NEC Nil by mouth
- IV fluids
- TPN
- Antibiotics
- NG tube to drain fluid and gas from stomach and intestines
May need surgery to remove dead bowel tissue
May have temporary stoma
What are the complications of NEC?
- Perforation and peritonitis
- Sepsis
- Death
- Strictures
- Abscess formation
- Recurrence
- Long term stoma
- Short bowel syndrome after surgery
