![]() ![]() Before referring for a paediatric surgical opinion, determine the severity of the disease with a scale such as the Modified Bell’s Staging Criteria. Once the infant has been stabilised, they should be referred for definitive management. They should be given IV fluids equal to the maintenance requirements plus replacement volumes of NG aspirates. A nasogastric tube should be inserted for decompression, aspirated at regular intervals and left on free drainage. They need continuous cardiac and saturation monitoring as well as temperature control. Keep the infant warm by nursing in an incubator, supine with their head slightly elevated. An abdominal x-ray including a lateral decubitus view should be done to look for dilated loops of the bowel, pneumatosis intestinalis, portal venous air and pneumoperitoneum. These may demonstrate thrombocytopenia, neutropenia, elevated CRP and metabolic acidosis. Once NEC is suspected, perform baseline investigations promptly. Increasing abdominal distension, with distended veins, discolouration or erythema are classics, often with reduced bowel sounds or a palpable abdominal mass. Other features include bilious aspirates or vomits and sometimes bloody stools. Infants with NEC are usually systemically unwell with poor perfusion, temperature instability, apnoea and/or bradycardia, hypotension and lethargy. ![]() Other risk factors include enteral feeding, formula feeding, bowel ischaemia, polycythaemia and recent surgery. Gastrointestinal immaturity in premature infants, together with the poor gastrointestinal blood supply in infants with growth restriction, are probably causative. The exact mechanism is not well understood. NEC has a 20-40% mortality rate and of those who survive, 25% develop long-term sequelae. 90% of babies are preterm, and most are very low birth weight infants with growth restriction. This may lead to bowel perforation and subsequently peritonitis, sepsis and death. Necrotising enterocolitis (NEC) occurs when sections of bowel tissue undergo inflammation leading to bacterial invasion and necrosis. ![]()
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