Necrotizing Enterocolitis (NEC)

Overview

Necrotizing enterocolitis (NEC) is a serious condition characterized by the necrosis of the intestinal mucosa, primarily affecting the colon. This can potentially lead to perforation, pneumatosis intestinalis, free air in the abdomen, and portal venous gas.

Presentation

1. More common in premature infants than term infants.

2. Symptoms include vomiting (feeding intolerance), decreased activity, and fluctuating body temperature.

3. Physical signs include abdominal distension and bloody stools.

4. Abdominal plain film may show air in the bowel wall.

Diagnosis

. Bell’s Criteria/Staging System: Used to categorize the severity of NEC.

. Abdominal X-ray (Initial): Supine antero-posterior and lateral decubitus positions are recommended.

. Bloods: Includes blood film, culture, coagulation studies, and blood gas analysis.

Treatment

Initial Steps:

Cease feeding (NPO).

Use a nasogastric (NG) tube for free drainage with aspiration.

Initiate antibiotics

Maintain fluids and electrolyte balance.

Antibiotics: Not Important for this exam. A regimen often used includes penicillin, gentamicin, and metronidazole.

Surgical Intervention: Required if pneumoperitoneum is detected (abnormal presence of air in the abdominal cavity).

Further Reading: Necrotising Enterocolitis