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Small Gut, Big Problem

Necrotising enterocolitis (NEC) is the most common gastro-intestinal emergency seen in preterm babies and is a common cause of neonatal morbidity and mortality. Management of acute NEC is complex...

NEC is far more common in babies born at less than 32 weeks’ gestation; it affects 1 in 13 babies born weighing <1,500 grams. NEC may occur term babies too although it is rare and usually associated with an underlying circulatory condition (e.g. congenital heart disease)...

Before we dive head first into the nitty gritty of it, let’s pause and think about which babies get NEC. Prematurity is by far the biggest risk factor but other risk factors include:

1. A history…

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  Emergency Management

MORAL of the Story – NEC can present to you in the Emergency Department!

  Necrotizing Enterocolitis: The Future

Necrotizing enterocolitis (NEC) is a disease seen primarily in preterm infants]. In some ways, NEC is a byproduct of the successes experienced in neonatology wherein babies of low gestational age who would not have survived 30–40 years ago are now surviving. NEC has emerged as one of the most destructive diseases occurring in neonatal intensive care. In addition to extremely high morbidity and mortality and high costs, long-term complications include strictures and adhesions of the intestine, cholestasis, short bowel syndrome, failure to thrive, and neurodevelopmental delay.

Articles of Interest

Colour of bile vomiting in intestinal obstruction in the newborn: questionnaire study

Because bile enters the intestine in the second part of the duodenum, intestinal obstruction below this level can result in bile in the vomit or gastric aspirate.

Cutting-Edge Discovery Points to Potential Treatment for Necrotizing Enterocolitis in Preemies

Dr. Hunter and colleagues found that a protein that causes pores in the intestine (called claudin 2) is increased in NEC, which makes the intestinal wall more permeable and allows bacteria to enter, which can result in sepsis or possibly death. They also found that they can prevent this process in an animal model by inhibiting a special molecule (called ROCK) that upregulates claudin 2.

Evidence-Based Management Of Neonatal Vomiting In The Emergency Department

Vomiting in the neonate is a common presenting complaint in the emergency department (ED), with etiologies ranging from benign to life-threatening. Vomiting and feeding difficulties have been reported in 11% to 36% of neonates who visit the ED. Vomiting (particularly bilious emesis) must be considered a surgical emergency until proven otherwise. The incidence of bilious emesis indicative of a surgical obstruction is reported to be between 20% and 38%

Necrotizing Enterocolitis and More

Necrotizing Enterocolitis (NEC) presents in the first few days of life (often in the NICU) to 3 weeks old. Risk factors include prematurity, excess feeding, neonatal sepsis Pneumatosis Intestinalisis on abdominal xray caused by bacterial translocation into the bowel wall. Treated with NG tube, bowel rest and surgical resection.

Resources

NEC Society

The NEC Society represents a diverse global community dedicated to building a world without necrotizing enterocolitis.

emDocs

Typically presents in 1st week of life (case reports to 6 months in chronically ill children). Extend suspicion longer in NICU graduates. Up to 10% of all cases of necrotizing enterocolitis are in full-term children.

Geeky Medics

NEC is the most common surgical emergency in the neonatal period. It is most common in underweight, pre-term infants fed with cow’s milk formula. NEC presents with blood in the stool, problems with feeding and abdominal distension.

CoreEM

Diagnosis is made by abdominal radiographs, which can show nonspecific findings including distension and thickened bowel wall. Pneumatosis intestinalis is pathognomonic for NEC, and is characterized by bowel wall lucencies.

Pediatrics Clerkship

Typically symptoms of NEC begin 8 to 10 days after birth, with a later onset among more premature infants.

Great Ormond Street Hospital for Children NHS

NEC is the most common surgical emergency in newborn babies and tends to affect more babies born prematurely than those born full-term. NEC seems to becoming more common, but it is likely that this is because more premature babies are surviving.

NORD

NEC remains a leading cause of morbidity and mortality in the neonatal intensive care unit despite significant advances in the care being provided to premature infants. It remains primarily a disease of prematurity

StatPearls

Signs and symptoms of NEC are non-specific and may include poor feeding, vomiting, lethargy, abdominal tenderness.