NEC

Question 1

You are the FY working in the neonatal unit and are called to review a baby who has had a bilious vomit, he was born at 27+2 weeks gestation and is now at day 3 of life. He weighs 800g (2^nd centile) and has had an uncomplicated admission so far. You discuss him with your seniors who are concerned he may have necrotising enterocolitis (NEC).

(a) Give two other differentials for bilious vomiting in neonates?

Answer 1

1. malrotation
2. volvulus
3. duodenal atresia OR Small bowel atresia
4. meconium ileus/plug

Question 2

(b) What two other signs would you look for in this baby that could suggest NEC?

Answer 2

1. abdominal distention
2. pyrexia
3. blood in stool
4. tachycardia
5. feed intolerance
6. increased requirement for respiratory support
7. jaundice

Question 3

(c) You decide to get an abdominal film to assist with your diagnosis, what feature of NEC can be seen on this abdominal film?

Answer 3

1. dilated loops of bowel
2. bowel wall oedema

Question 4

(d) What two other common conditions of extreme prematurity might this baby be at risk of?

Answer 4

1. retinopathy of prematurity
2. intraventicular haemorrhage
3. respiratory distress syndrome OR chronic lung disease of prematurity
4. patent ductus arteriosus

Question 5

(e) What management should be considered?

Answer 5

1. Withhold feeds
2. Fluid bolus
3. Antibiotics

Question 6

(f) Name two complications of NEC?

Answer 6

1. Death
2. Sepsis
3. Short bowel
4. Respiratory compromise from distended abdomen
5. Peritonitis
6. Intestinal perforation
7. Intestinal stricture
8. Liver problems secondary to long-term parenteral feeding