Necrotizing enterocolitis: Difference between revisions
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==Background== | ==Background== | ||
* | *Abbreviation: NEC | ||
*Intestinal necrosis in previously well infant | *Intestinal necrosis in previously well infant | ||
*Predominantly affects preemies; 10-15% occurs in full-term | *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 | *Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production | ||
== | ==Clinical Features== | ||
*Poor feeding, lethargy, | *[[Failure to thrive (peds)|Poor feeding]], [[altered mental status (peds)|lethargy]], [[abdominal pain|abdominal distention/tenderness]] | ||
*Sepsis, pneumoperitoneum | *[[Sepsis]], pneumoperitoneum | ||
==Work-Up== | ==Differential Diagnosis== | ||
{{Pediatric abdominal pain DDX}} | |||
==Evaluation== | |||
[[File:Necrotizing enterocolitis 202.jpg|thumb|Neonate with necrotizing enterocolitis.]] | |||
[[File:PMC3800332 IJA-57-387-g001.png|thumb|Left: [[KUB]] with pneumatosis intestinalis (large arrow) a specific finding in necrotizing enterocolitis. Right: follow-up film showing free air indicating bowel perforation (small arrow).]] | |||
===Work-Up=== | |||
*CBC | *CBC | ||
*Chem | *Chem | ||
*Sepsis evaluation | *[[Sepsis (peds)|Sepsis]] evaluation | ||
*Coags | *Coags | ||
*Stool +/- heme positive | |||
* | |||
===Radiography=== | ===Radiography=== | ||
*Pneumatosis on XR is hallmark | *Pneumatosis on XR is hallmark | ||
**Get KUB in supine position and left lat decubitus | **Get [[KUB]] in supine position and left lat decubitus | ||
* | *[[Ultrasound: Abdomen|Ultrasound]] | ||
**Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim | **Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim | ||
**Assess for gas bubbles in liver and portal veins | **Assess for gas bubbles in liver and portal veins | ||
== | ==Management== | ||
#NPO | #NPO | ||
#Aggressive IV hydration | #Aggressive [[IVF|IV hydration]] | ||
# | #[[Ampicillin]] + [[gentamicin]] + [[clindamycin]] | ||
#Surgery consult | #Surgery consult | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
[[Abdominal | *[[Abdominal pain (peds)]] | ||
==References== | |||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | |||
Latest revision as of 22:17, 7 October 2021
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
Left: KUB with pneumatosis intestinalis (large arrow) a specific finding in necrotizing enterocolitis. Right: follow-up film showing free air indicating bowel perforation (small arrow).
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