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Necrotising Enterocolitis/NEC

Necrotising Enterocolitis is a disorder that affects premature neonates, in which part of the bowel becomes ischaemic and infected. If left untreated, the bowel can perforate, therefore leading to peritonitis and shock. It usually presents in the first 3 weeks of life.


Presentation

  • Abdominal distension

  • Bilious vomiting

  • Bloody stools


O/E - Absent bowel sounds


Investigations

  • Bloods – FBC, WCC, CRP, Culture

  • Blood gas – Metabolic (lactic) acidosis

  • Abdominal XR - This may show:

    • Pneumatosis Intestinalis – Gas within bowel wall

    • Dilated bowel loops

    • Bowel wall oedema

    • Gas in portal veins

    • Pneumoperitoneum if perforation occurs

“Pneumatosis intestinalis and hepatis in necrotizing enterocolitis” © Hellerhoff CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

  • Bowel rest - NBM, NGT, IVF

  • Abx to clear the infection

  • Surgery if perforation or refractory - dead bowel tissue has to be removed




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