Necrotising Enterocolitis
Gastroenterology
Presentation
Apnoea
Feed intolerance:
- Aspirates
- Bilious
- Residual volume: Gastric retention (prior to next feed)
- Vomiting - bilious
Diarrhoea
Haematochezia
Hypotension
Temperature instability
Abdominal
- distension
- erythema
- induration
- crepitations
- tenderness
Risk factors
- cardiac surgery
- hypoxia
Ix
Hb - Anaemia
Plt - thrombocytopaenia
Albumin - hypoalbuminaemia ?predicts need for surgery
Coags - DIC
Blood culture
AXR
- pneumoperitoneum
- portal gas
- intramural gas
Rx
NBM NG free drainage
IVF/inotropes
IVABs
TPN
If signs of perforation/peritonitis ? laparotomy V ? Primary peritoneal drainage
DDx
Spontaneous ileal perforation
- similar age and presentation to NEC but WITH pneumoperitoneum WITHOUT intramural gas/portal gas/erythema of skin
Rx is the same
Presentation
Apnoea
Feed intolerance:
- Aspirates
- Bilious
- Residual volume: Gastric retention (prior to next feed)
- Vomiting - bilious
Diarrhoea
Haematochezia
Hypotension
Temperature instability
Abdominal
- distension
- erythema
- induration
- crepitations
- tenderness
Risk factors
- cardiac surgery
- hypoxia
Ix
Hb - Anaemia
Plt - thrombocytopaenia
Albumin - hypoalbuminaemia ?predicts need for surgery
Coags - DIC
Blood culture
AXR
- pneumoperitoneum
- portal gas
- intramural gas
Rx
NBM NG free drainage
IVF/inotropes
IVABs
TPN
If signs of perforation/peritonitis ? laparotomy V ? Primary peritoneal drainage
DDx
Spontaneous ileal perforation
- similar age and presentation to NEC but WITH pneumoperitoneum WITHOUT intramural gas/portal gas/erythema of skin
Rx is the same