Necrotizing Enterocolitis NEC

Necrotizing enterocolitis is most commonly seen in premature infants and presents as intolerance of feeds which progresses to distension and bloody stools. It may be associated with ischemia, malnutrition, and use of synthetic formulas. Radiographic findings may include pneumatosis intestinalis which is caused by gas forming bacteria. Initial treatment is to stop the tube feeds, place an NG for decompression, and start TPN and antibiotic therapy. Surgery involves resection of the affected bowel with ostomy and is performed on those infants with free air, refractory acido-sis, peritoneal signs, or gas within the portal vein among other findings. If laparo-tomy reveals massive gangrene/necrosis, only the bowel which is clearly necrotic is

resected, and a reexploration is performed 24 hours later. Another option is that of intraabdominal drain placement, which is often reserved for infants weighing less than 1.5 kg. Survival is approximately 80% overall.

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