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Necrotizing enterocolitis
From WikEM
(Redirected from Necrotizing Enterocolitis (NEC))
Contents
Background
- Abreviation: NEC
- Intestinal necrosis in previously well infant
- Predominantly affects preemies; 10-15% occurs in full-term patients
- Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production
Clinical Features
- Poor feeding, lethargy, abdominal distention/tenderness
- Sepsis, pneumoperitoneum
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Evaluation
Work-Up
- CBC
- Chem
- Sepsis evaluation
- Coags
- Stool +/- heme positive
Radiography
- Pneumatosis on XR is hallmark
- Get KUB in supine position and left lat decubitus
- US
- Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
- Assess for gas bubbles in liver and portal veins
Management
- NPO
- Aggressive IV hydration
- Ampicillin + gentamycin + clindamycin
- Surgery consult
Disposition
- Admit
