Necrotising enterocolitis

Question 1

What is necrotizing enterocolitis (NEC)?

Answer 1

• a disorder affecting premature neonates, where part of the bowel becomes necrotic
• it’s a life threatening emergency
• death of the bowel tissue can lead to bowel perforation ⇒ peritonitis and shock

Question 2

What are some risk factors for NEC?

Answer 2

• very low birth weight or very premature
• formula feeds (it’s lesson common in babies fed by breast milk feeds)
• respiratory distress and assisted ventilation
• sepsis
• patent ductus arteriosus and other congenital heart disease

Question 3

How does NEC present?

Answer 3

• intolerance to feeds
• vomiting, particularly with green bile
• generally unwell
• distended, tender abdomen
• absent bowel sounds
• blood in stool
• when perforation occurs there’ll be peritonitis and shock and the neonate will be severely unwell

Question 4

Which blood tests are done for NEC?

Answer 4

• FBC for thrombocytopenia and neutropenia
• CRP
• CBG will show metabolic acidosis
• blood culture for sepsis.

Question 5

What is the investigation of choice for diagnosing NEC?

Answer 5

Abdominal x-ray, done anteroposteriorly with the infant in the supine position. Additional views can be helpful such as lateral and lateral decubitus.

Question 6

What will an abdominal x-ray show in NEC?

Answer 6

• dilated loops of bowel
• bowel wall oedema (thickened bowel walls)
• pneumatosis intestinalis is the gas in the bowel wall and is a sign of NEC
• pneumoperitoneum is free gas in the peritoneal cavity and indicates perforation
• gas in the portal veins

Question 7

What is the management for NEC?

Answer 7

• NBM
• IV fluids
• total parenteral nutrition (TPN)
• antibiotics
• NGT can be inserted to drain fluid and gas from the stomach and intestines
• surgery may be needed to remove the dead bowel tissue and babies may be left with a temporary stoma if significant bowel is removed

Question 8

What are the short-term complications of NEC?

Answer 8

Perforation and peritonitis, sepsis, death.

Question 9

What are the long-term complications of NEC?

Answer 9

Strictures, abscess formation, recurrence, long-term stoma, short bowel syndrome after surgery.