Necrotizing enterocolitis (NEC)

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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.


Prevention:
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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