Critical Care Medicine
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.
Most infants diagnosed with NEC are premature but are relatively healthy and feeding well prior to the development of NEC.
Signs of sepsis
Lack of bowel sounds
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
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:
Low neutrophil count
4. Specific Treatment
Fluid resuscitation and replacement of insensible losses
Bowel rest with NG suction
Total parenteral nutrition
Antibiotic coverage (see below)
Laparotomy with resection of necrotic bowel and peritoneal drain placement
Drugs and dosages
Vancomycin, gentamicin, and clindamycin or metronidazole or piperacillin-tazobactam.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Clinical Pain Advisor Articles
- Sustained-Release Sodium Nitrite for Diabetic Neuropathic Pain Not Associated With Headaches
- Treatment for Opioid Use Disorder Associated With Reduced Risk for Opioid-Related Deaths
- Clonidine May Not Improve Post-Cesarean Delivery Analgesia
- No Added Value With Liposomal Bupivacaine Following TKA With Peripheral Nerve Block
- Rapid Decrease of Heroin Use During Opioid Substitution Treatment Associated With Treatment Success
- Recommendations for Perioperative Pain Management in Patients With Opioid Tolerance
- Vertebroplasty Comparable With Placebo for Acute Vertebral Compression Fractures
- Capsaicin 8% Patch May Be Effective in Neuropathic Pain
- Detox vs Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Expert Roundtable
- Prior Authorization Policy May Help Reduce Long-Acting Opioid Use
- Opioid-Related Deaths Represent Significant Public Health Burden
- Addressing Confidentiality Concerns With Electronic Access to Pediatric Medical Records
- Opioid-Related Adverse Events Common After Invasive Procedures
- Diagnosis and Treatment of Migraine in Children Should Consider Atopy
- Led by AG Sessions, DOJ Declines to Defend ACA Against Federal Lawsuit