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.
Clinical features
Most infants diagnosed with NEC are premature but are relatively healthy and feeding well prior to the development of NEC.
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Feeding intolerance
Apnea/respiratory failure
Signs of sepsis
Abdominal distention
Hematochezia
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
3. Diagnosis
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:
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Metabolic acidosis
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Low platelets
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Low neutrophil count
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Prolonged PT/PTT
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High glucose
4. Specific Treatment
Medical Management
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Fluid resuscitation and replacement of insensible losses
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Bowel rest with NG suction
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Total parenteral nutrition
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Antibiotic coverage (see below)
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Radiographic monitoring
Surgical Management
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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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