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Potentially life-threatening emergency
Necrotizing enterocolitis
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Potentially life-threatening emergency

Necrotizing enterocolitis

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Contributors: Amirah Khan MD, Christine Osborne MD, Eric Ingerowski MD, FAAP
Other Resources UpToDate PubMed

Synopsis

Necrotizing enterocolitis (NEC) is a serious, life-threatening, acute inflammatory disease of the intestinal wall that can range in severity from intestinal mucosal damage to full-thickness intestinal wall necrosis with resultant perforation. NEC is more prevalent in premature infants, with incidence inversely related to gestational age and birth weight. While NEC is most common in infants weighing less than 1000 grams, it may also affect full-term infants. In premature infants, NEC typically presents in the second or third week of life and is more common in formula-fed infants, while NEC in full-term infants presents in the first 3 days of life. Prematurity and milk feeding are 2 risk factors for the development of NEC. Mortality from NEC ranges from 15%-30% and is inversely proportional to gestational age and birth weight.

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, and hypotension are also possible. 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.

Codes

ICD10CM:
P77.9 – Necrotizing enterocolitis in newborn, unspecified

SNOMEDCT:
2707005 – Necrotizing enterocolitis in fetus OR newborn

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 04/18/2018
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Potentially life-threatening emergency
Necrotizing enterocolitis
Print 3 Images
View all Images (3)
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Necrotizing enterocolitis (Stage IA) : Fatigue, Vomiting, Abdominal distension, Apnea, Heme+ stool
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