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Safer Care Victoria
Necrotising Enterocolitis
Necrotising enterocolitis (NEC) is the most common gastrointestinal (GI) emergency in neonates, and 90% of babies with NEC are preterm. NEC is an illness involving injury to the small or large intestines. If the injury spreads, there may be a perforation allowing bacteria to leak out and cause an intro abdominal infection, and thus, these babies can become incredibly sick.
NEC is difficult to diagnose and mortality rates are 20-40%. Therefore, if in doubt, treat early and conservatively. There is no current known single cause of NEC. There are however a multitude of associated risk factors, with the most significant being prematurity, identified by research as the most significant risk factor for developing NEC.
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Signs & Symptoms
Early signs of NEC often present similar to other medical problems, and thus, obtaining a diagnosis of NEC is difficult.
GI symptoms can include:
☞ Swollen and/or tender stomach
☞ Bloody bowel movements
☞ Little to no interest in feeding
☞ Increased aspirates from enteral feeding tubes
☞ Green coloured vomit/drainage
Systemic symptoms can include:
☞ Signs of infection, including apnea and lethargy
☞ Low or high temperatures & temperate instability
☞ bradycardia
☞ Hypotension
☞ acidosis
☞ Reddish skin over stomach
Diagnosing NEC
Abdominal X-rays look for NEC, and can show multiple small bubbles in the intestinal wall. Ongoing X-rays track the illness, and in severe cases of NEC, X-rays may show air or gas from a hole in the intestines.
Treatment & Management
Babies will be treated as per a polar such as the Modified Bell's staging criteria above. They will be nil by mouth with a gastric tube on free drainage. Blood cultures will be taken and antibiotics commented, which may include vancomycin, gentamicin, or metronidazole (which is only used for definite NEC).
There should be gut rest for 10-14 days, TPN administration to meet metabnolic and nutritional demand, fluid management, inotropes, ventilation, analgesia and frequent radiographs. in 20-25% of cases, babies will require surgical intervention. Note that there is a possibility that the baby will require an ileostomy.
Follow up Management
Babies who survive NEC are at a greater risk of developmental problems compared to other babies, especially if surgical intervention was undergone. However close follow up is necessary either way once baby goes home. They may experience gut and/or nutrition issues, and should be followed up in this case with a specialist.
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