Necrotizing enterocolitis: Difference between revisions
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==Management== | ==Management== | ||
#NPO | #NPO | ||
#Aggressive IV hydration | #Aggressive [[IVF|IV hydration]] | ||
#[[Ampicillin]] + [[gentamicin]] + [[clindamycin]] | #[[Ampicillin]] + [[gentamicin]] + [[clindamycin]] | ||
#Surgery consult | #Surgery consult | ||
Revision as of 23:11, 29 September 2019
Background
- Abbreviation: NEC
- Intestinal necrosis in previously well infant
- Typically presents in 1st week of life, with case reports to 6 months in children that are chronically ill.
- Predominantly affects preemies; 10-15% occurs in full-term patients
- Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production
Clinical Features
- Poor feeding, lethargy, abdominal distention/tenderness
- Sepsis, pneumoperitoneum
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Evaluation
Work-Up
- CBC
- Chem
- Sepsis evaluation
- Coags
- Stool +/- heme positive
Radiography
- Pneumatosis on XR is hallmark
- Get KUB in supine position and left lat decubitus
- Ultrasound
- Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
- Assess for gas bubbles in liver and portal veins
Management
- NPO
- Aggressive IV hydration
- Ampicillin + gentamicin + clindamycin
- Surgery consult
Disposition
- Admit