pediatrics
Necrotizing Enterocolitis
Key Points
Necrotizing enterocolitis (NEC) is intestinal necrosis of uncertain etiology; it occurs mainly in preterm or sick neonates after enteral feedings have begun. Complications include intestinal perforation (most often in the terminal ileum) and peritonitis; sepsis occurs in 20 to 30%, and death may occur in 20%. Initial manifestations are feeding difficulties and bloody or bilious gastric residuals (after feedings) followed by bilious emesis, abdominal distention, and/or gross blood in stool. Diagnose using plain x-rays. Supportive treatment using fluid resuscitation, nasogastric suction, broad-spectrum antibiotics, and total parenteral nutrition is effective in > 75% of cases. Surgery to resect gangrenous bowel and treat perforation is needed in<25% of infants. 