0 Necrotizing enterocolitis (NEC)

Necrotizing enterocolitis (NEC)

Necrosis of immature gut.

Risk factors : 
  1. Prematurity
  2. Ischemia to intestinal mucosa because of RDS/HIE/Hypothermia
  3. Artificial feed
  4. Maternal Cocaine

Clinical Features :
  • of Sepsis 
  • Abdominal distention 
  • Blood in stools

BELL'S Staging :

I - Suspected NEC -
  • Abdominal distention
  • Paralytic Ileus
  • Occult blood in stool

II - Definite
  • IIa - Gross blood in stools , Hyponatremia , Metabolic acidosis , Thrombocytopenia.
  • IIb - Pneumatosis Intestinalis (Air in Gut wall)

III - Advanced - Air perforated gut - Shock , Pneumoperitoneum.

Trophic feeds -
Minimal breast milk through NGT (nasogastric tube) {20-30 ml / kg / day}
  • It is for local effect on gut
  • Not for nutrition - for nutrition give IV fluids

Treatment :
  • Stop all oral feeds
  • Put on TPN (Total parenteral nutrition)
  • Ceftriaxone
  • Metronidazole
  • Stage III - May require Surgery -Resection 

Probiotics : Commensals - Prevent NEC ( Not for Treatment )
  • Lactobacillus acidophilus
  • Bifidobacterium infantis
to Very Low birth weight infant.

Also always Think of NEC in infant when :
  • Gas under diaphragm
  • Newborn with Right hypochondrial air in portal tract

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