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Necrotising Enterocolitis (NEC)

History

Typically affects preterm infants in their second or third week of life in the neonatal unit who are formula fed. In term infants, the reported median age of onset is 1-3 days, but onset may occur as late as 1 month.

Initial symptoms may be subtle and can include 1 or more of the following:

  • Vomiting

  • Diarrhoea

  • Abdominal distention, abdominal tenderness

  • Ileus/decreased bowel sounds

  • Abdominal wall erythema (advanced stages)

  • PR bleeding

Examination

Can vary from mild disease to peritonitis, shock and death. The first signs are abdominal distention with gastric retention, emesis, and discomfort. Infants may also present shocked with circulatory collapse and episodes apnoea, or bleeding eg PR from consumptive coagulopathy.

Investigations

  • FBC – Hb – blood loss, WBC – sepsis, Plt – thrombocytopenia

  • EUC – hyponatraemia

  • Lactate and bicarb – poor tissue perfusion, sepsis, infarction of bowel

  • Glucose

  • DIC and coags – consumptive coagulopathy

  • G&H +/- X-match depending on severity of bleeding

  • Blood and stool cultures

  • AXR – abnormal gas pattern, dilated loops, thickened bowel wall, free air, portal gas

  • USS (bedside) – free fluid. Formal USS can identify areas loculation +/- abscess and walled off perforation.

Treatment

  • Cease feeding

  • NG decompression

  • IV/IO fluid resuscitation

  • Electrolyte monitoring and replacement

  • ABx following cultures e.g.

    • Ampicillin 50mg/kg/dose iv/im 8 hourly

    • Gentamicin 5mg/kg iv/im 24 hourly

    • Metronidazole initial loading dose 15mg/kg

  • Close monitoring

  • Surgical and paediatric specialist review

  • Likely early retrieval to specialist paediatric centre

Further References and Resources

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