Critical Care Medicine
Gastrointestinal Emergencies: Necrotizing Enterocolitis (NEC)
Necrotizing Enterocolitis (NEC)
1. Description of the problem
NEC is characterized by ischemia and necrosis of the gastrointestinal tract and can lead to mortality and morbidity, including short bowel syndrome. It is most often found in premature infants and requires early recognition and treatment to prevent long segment bowel necrosis.
Most infants diagnosed with NEC are premature but are relatively healthy and feeding well prior to the development of NEC.
Signs of sepsis
Lack of bowel sounds
Key management points
Early Identification - pneumatosis intestinalis and ileus on AXR
Early Treatment - antibiotics, cessation of oral feeding, possible surgical exploration
Serial abdominal X-rays
The mainstay of NEC diagnosis remains abdominal radiography, although abdominal ultrasound may have some utility, especially with ultrasound expertise.
AXR - dilated bowel loops, ileus, pneumatosis intestinalis, pneumoperitoneum, fixed loops
While the diagnosis of NEC relies on radiographic evidence, laboratory evaluation may further suggest NEC. These findings include:
Low neutrophil count
4. Specific Treatment
Fluid resuscitation and replacement of insensible losses
Bowel rest with NG suction
Total parenteral nutrition
Antibiotic coverage (see below)
Laparotomy with resection of necrotic bowel and peritoneal drain placement
Drugs and dosages
Vancomycin, gentamicin, and clindamycin or metronidazole or piperacillin-tazobactam.
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