- Clinical science
Necrotizing enterocolitis (NEC) is a dangerous hemorrhagic inflammation of the intestinal wall that most often affects premature infants. Typical symptoms include abdominal distention, gastric retention, tenderness, rectal bleeding and visible intestinal loops lacking peristalsis; a radiographic finding of gas within the wall of the intestine (pneumatosis intestinalis) confirms the suspected diagnosis. Conservative management of the condition involves parenteral nutrition and antibiotics. In the case of advanced NEC and intestinal perforation, however, surgery is necessary.
- Hemorrhagic necrotizing inflammation of the intestinal wall
- The causes of necrotizing enterocolitis are not fully understood but multiple factors contribute to the development of the condition
Bell staging criteria
|Stage I|| || |
|Stage II|| || |
|Stage III|| |
- Complete blood count:
- ↑ Inflammatory markers
- Check for signs of DIC → see
- Arterial blood gas analysis: Metabolic acidosis is associated with advanced NEC.
- Blood culture
- Abdominal radiography
- Indication: Ultrasound may be helpful for diagnosing NEC when abdominal radiography is inconclusive.
- Pneumatosis intestinalis
- Portal venous gas
- Increased intestinal wall thickness
- Decreased intestinal wall perfusion
|NEC||Spontaneous intestinal perforation (Isolated perforation typically at the terminal ileum in an otherwise healthy appearing small bowel)|| |
|Infectious enteritis||Allergy to cow's milk|
| || || || |
|Other findings|| || || || || |
The differential diagnoses listed here are not exhaustive.
- Supportive care:
- IV broad-spectrum antibiotics
- Radiographic monitoring: plain supine abdominal radiographs every 6–12 hours in the initial phase of the disease
Surgery: primary peritoneal drainage and/or laparotomy with necrotic bowel excision
- Indications: perforation, peritonitis and/or clinical worsening despite medical therapy
Mortality rate: approx. 10–30%
Breast milk has a protective effect