Necrotizing enterocolitis

Background

usu 24-48 hr of life/neonates & premature infants
It is d/t intestinal wall necrosis

Diagnosis

S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools
radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen

Signs of functional Intestinal obstruction : Abdominal distension, progressive decreased Peristalsis, Bilious vomiting, hematemesis and blood in stools

Signs of peritonitis & perforation: Ascites, erythema & edema of abdominal wall, localized mass or rigidity

Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema

Triad of

Thrombocytopenia
Metabolic acidosis
Hyponatremia

Clinical triad

Distension
GI bleeding
Pneumatosis intestinalis

Stools are heme +

Radiography

Pneumotosis is hallmark
- Get KUB and left lat decubital

DDx

Sepsis
pneumonia
malro/volvulus
intuss
feeding intolerance (exclusion)

Treatment

NPO
CBC, lytes, BCx, x-ray
Amp/gent/clinda x 48 hrs
Serial CBC, lytes, x-ray (q6)
NG to suction
Volume replacement

Surgery Indications

Perforation
portal/biliary air
rapidly deteriorating

Prognosis

Rx= 80% nd only medical mgt (bowel rest, ngt, fluids, abx to cover bowel flora), 20% need bowel surgery (if perf etc)
15% mortality

Source

Adapted from Pani

Authors: