Symptoms include vomiting, diarrhea, high residual feed volume, rectal bleeding, and abdominal distension characterized by increased abdominal girth or abdominal wall erythema. Systemic signs such as apnea, lethargy, respiratory failure, thermostability, and hypotension are also possible. Abdominal x-ray may show dilated loops of bowel consistent with ileus, pneumatosis intestinalis, or pneumoperitoneum in the case of perforation. Diagnosing NEC as soon as possible to allow for prompt medical management is key. The Bell staging criteria can be used to classify the severity of illness, but management is based on clinical presentation.
If NEC is suspected, enteral feeds should be suspended and evaluation for NEC should commence.
Emergent Care / Stabilization: Initial stabilization measures should address the standard airway, breathing, and circulation (ABC). Enteral feeds should be immediately stopped and a Replogle tube placed. If apnea, respiratory distress, or hypoxia are present, intubation and mechanical ventilation may be required. Hypotension must be immediately addressed with fluid resuscitation and pressor support if needed. Transfer to a neonatal intensive care unit (NICU), if not already there, and consult pediatric surgery in severe cases of NEC or bowel perforation.
P77.9 – Necrotizing enterocolitis in newborn, unspecified
2707005 – Necrotizing enterocolitis in fetus OR newborn
- Apnea of prematurity
- Congenital heart disease
- Hirschsprung disease
- Inborn error of metabolism
- Food protein-induced enterocolitis syndrome
- Cow's milk allergy
- Infectious enteritis (Campylobacter spp, Clostridioides difficile, Salmonella spp, and Shigella spp)
- Intestinal volvulus
- Meconium ileus