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

Clinical triad : Abdominal. Distension + GI bleeding + Pneumatosis intestinalis

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

Stools are heme +

Radiography

-Pneumotosis is hallmark

Get KUB and left lat decubital

DDx

Sepsis, pneumonia, malro/volvulus, intuss, feeding intolerance (exclusion)

Treatment

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

Management

-NPO

-CBC, lytes, BCx, x-ray

-Abx x 48 hrs

-Serial CBC, lytes, x-ray (q6)

Treatment:

NG to suction

NPO

Amp/gent/clinda

Volume replacement

Support

Surgery indications

-Perforation, portal/biliary air, rapidly deteriorating

Source

Adapted from Pani

Authors: