Necrotising Enterocolitis

Question 1

What group of patients does necrotising enterocolitis affect?

Answer 1

Neonates

Question 2

Why is necrotising enterocolitis life-threatening?

Answer 2

Risk of bowel perforation leading to peritonitis, sepsis and shock

Question 3

What are risk factors for developing necrotising enterocolitis?

Answer 3

Very low birth weight
Extremely premature
Formula feeding
RDS and assisted ventilation
Sepsis
Patent ductus arteriosus

Question 4

How do neonates with necrotising enterocolitis present?

Answer 4

Intolerance to feeds
Vomiting green bile
Generally unwell
Distended, tender abdomen
Absent bowel sounds
Blood in stool

Question 5

What blood tests are ordered in suspected necrotising enterocolitis?

Answer 5

FBC for thrombocytopenia and neutropenia
CRP
Capillary blood gas (metabolic acidosis)
Blood culture to identify sepsis

Question 6

What is the initial investigation for suspected necrotising enterocolitis?

Answer 6

Abdominal x-ray in anteroposterior view with infant supine (on back)

Question 7

What positions would be helpful to detect free gas indicating perforation in an X-ray?

Answer 7

Lateral (from side with infant on back)
Lateral decubitus (from side with infant on their side)

Question 8

What may be seen on an X-ray in necrotising enterocolitis?

Answer 8

Dilated loops of bowel
Bowel wall oedema (thickened walls)
Pneumatosis intestinalis (free gas in bowel wall)
Pneumoperitoneum (free gas in cavity)
Gas in portal veins

Question 9

How is necrotising enterocolitis managed?

Answer 9

Nil by mouth
IV fluids and TPN
Antibiotics
NG tube to drain fluid and gas from stomach and intestines

Question 10

What may happen in a surgery for necrotising enterocolitis?

Answer 10

Removal of dead bowel tissue.
May leave temporary stoma if significant section of bowel removed

Question 11

What are complications of necrotising enterocolitis?

Answer 11

perforation and peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence
Long-term stoma
Short bowel syndrome after surgery