Necrotizing enterocolitis


  • 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

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence


Neonate with necrotizing enterocolitis.
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).


  • CBC
  • Chem
  • Sepsis evaluation
  • Coags
  • Stool +/- heme positive


  • 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


  1. NPO
  2. Aggressive IV hydration
  3. Ampicillin + gentamicin + clindamycin
  4. Surgery consult


  • Admit

See Also