Necrotizing enterocolitis
Background
- Abreviation: NEC
- Intestinal necrosis in previously well infant
- Predominantly affects preemies; 10-15% occurs in full-term pts
- Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production
Diagnosis
- Poor feeding, lethargy, abd distention/tenderness
- Sepsis, pneumoperitoneum
- Stool is +/- heme +
Work-Up
Labs
- CBC
- Chem
- Sepsis evaluation
- Coags
Imaging
- Cross-table lateral to detect free air
- Pneumatosis intestinalis, pneumobilia, pneumoperitoneum, sentinel loops, portal gas
Radiography
- Pneumatosis on XR is hallmark
- Get KUB in supine position and left lat decubitus
- US
- Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
- Assess for gas bubbles in liver and portal veins
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Treatment
- NPO
- Aggressive IV hydration
- Amp/gent/clinda x 48 hrs
- Surgery consult
See Also
Source
Tintinalli