Gastrointestinal Emergencies: Necrotizing Enterocolitis (NEC)

Necrotizing Enterocolitis (NEC)

1. Description of the problem

NEC is characterized by ischemia and necrosis of the gastrointestinal tract and can lead to mortality and morbidity, including short bowel syndrome. It is most often found in premature infants and requires early recognition and treatment to prevent long segment bowel necrosis.

Clinical features

Key management points

Early Identification – pneumatosis intestinalis and ileus on AXR

Early Treatment – antibiotics, cessation of oral feeding, possible surgical exploration

Serial abdominal X-rays

3. Diagnosis

The mainstay of NEC diagnosis remains abdominal radiography, although abdominal ultrasound may have some utility, especially with ultrasound expertise.

AXR – dilated bowel loops, ileus, pneumatosis intestinalis, pneumoperitoneum, fixed loops

While the diagnosis of NEC relies on radiographic evidence, laboratory evaluation may further suggest NEC. These findings include:

Metabolic acidosis
Low platelets
Low neutrophil count
Prolonged PT/PTT
High glucose

4. Specific Treatment

Medical Management

Fluid resuscitation and replacement of insensible losses
Bowel rest with NG suction
Total parenteral nutrition
Antibiotic coverage (see below)
Radiographic monitoring

Surgical Management

Laparotomy with resection of necrotic bowel and peritoneal drain placement

Drugs and dosages

Vancomycin, gentamicin, and clindamycin or metronidazole or piperacillin-tazobactam.

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