Necrotising+Enterocolitis

=Necrotising Enterocolitis=

What it is
Necrotising enterocolitis (NEC) is the most common gastrointestinal (GI) emergency in neonates. Ninety percent of babies with NEC are preterm. It is predominantly a disease of the very low birthweight infant and is most common in babies < 1000 g or those that are both preterm and growth restricted. The incidence of NEC is inversely proportional to birthweight. In general, the age of onset is inversely proportional to gestation; therefore smaller babies present later.

Approximately 50% of babies developing NEC require surgery. The mortality rate of NEC is 20-40%. Of those who survive, approximately 25% develop long term sequelae. Early or suspected NEC is often difficult to diagnose as the clinical signs and symptoms are often non-specific, as are the radiological and laboratory findings. As babies with definite NEC should be transferred to a level III unit, this topic will concentrate mainly on the presentation and diagnosis of NEC as well the level II management of a baby who has had previous NEC.

- prematurity - enteral feeding (although approx. 10% of cases occur in infants **never** fed) - formula feeding (6 times more common than if only breast milk fed) - often occurs in clusters (although organisms vary) - bowel ischaemia
 * Risk Factors**

in term infants: - polycythaemia - cardiac surgery - abdominal surgery (esp. gastroschisis, intestinal atresia) - endocrine abnormalities

Symptoms
GI dysfunction - abdominal distention - vomiting - bilious drainage from enteral feeding tubes - blood in stool systemic - temperature instability - apnoea and/or bradycardia - lethargy - hypotension

Determine the severity and management using the __ Modified Bell's Staging Criteria for Necrotising Enterocolitis __

How to Treat
//see ‘Modified Bell’s Staging Criteria’ for duration// - nil by mouth - gastric tube on free drainage - blood culture antibiotics - vancomycin - gentamicin - metronidazole ( only for definite NEC)

//cases of definite NEC should be referred to a level III NICU for management, as the following (may be) required// - gut rest for 10-14 days - total parenteral nutrition - fluid management - inotropes - ventilation - analgesia - frequent radiographs - surgery (25% to 50% of cases)

Additional Resources
[|RCH - Necrotising Enterocolitis]