Necrotising Enterocolitis

(NEC)

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Features

-  Most common GIT surgical emergency in neonates

-  10% infants < 1500g

-  More common in premature infants

-  Onset

-  Term babies: average 1-3 days of life upto 4 weeks

-  Premature: up to several weeks after birth

-  Mortality rate 50% depending on severity

-  Unknown aetiology

 

Associated S/S

-  Feeding intolerance

-  Abdominal distension &/or tenderness

-  Ileus or decreased bowel sounds

-  Abdominal wall erythema

-  Haemotchezia

-  Apnoea

-  Lethargy

-  Decreased peripheral perfusion --> shock

-  Cardiovascular collapse

-  Bleeding diathesis

 

Ix

-  U&E: hyponatraemia: capillary leak

-  ABGs: Metabolic acidosis: sepsis, bowel necrosis

-  FBE: leukopaenia or leukocytosis, thrombocytopaenia, neutropaenia

-  PT, APTT: coagulopathy

-  AXR: AP & lateral decubitus

-  Dilated bowel loops, thickened bowel walls, absent intestinal gas, penumoperitoneum

-  Pneumatosis intestinalis

-   Pathognomic of NEC

-  May also be ass w bowel Ca

-   Train track lucency of bowel wall

-   Air trapped within bowel wall

 

Pneumatosis Intestinalis 1

 

-  Abdominal US

-  Portal venous gas, ascities

 

Mx

-  IVC or CVC

-  Abdominal decompression

-  NBM for 48hrs then breast milk

-  Probiotics

-  As per Staging (below)

-  Surgery

-  Bowel resection w ileostomy & later reasnastmosis

 

Bells Staging (I-III)

-  Stage I

-  Stage 1A: mild distension

-  Stage 1B: 1A + grossly bloody stool

-  NBM w TPN & IV fluids

-  Abx 3 days

-  Stage 2

- Stage 2A

-  1 + absent BS & tenderness

-  AXR: ielus or pneumatosis intestinalis

- Stage 2B

-  2A + Metabolic acidosis or thrombocytopaenia, RLQ mass, abdo erythema

-  AXR: portal venous gas +/- ascities

- NBM w TPN & IV fluids

- Abx 14 days

- Sx review

-  Stage 3

- Stage 3A

-  2 + hypotension, bradycardia, resp failure, neutropaenia

-  Marked distension & generalized peritonitis

-  AXR: ascities

- Stage 3B

-  Severely ill w perforated bowel on AXR

- NBM 14 days w TPN

- IV fluids + Resus

- Ionotropic & ventilatory support

- Sx