Necrotising Enterocolitis (NEC)

Why is this topic important?

One of the most serious gastrointestinal emergencies in neonatology.

Definition

Inflammatory bowel disease of neonates leading to bowel necrosis.

Key MRCPCH Facts

• Mainly affects preterm infants

• Human milk is protective

• Pneumatosis intestinalis is characteristic

Clinical Features

• Abdominal distension

• Feed intolerance

• Bile-stained aspirates

• Bloody stools

• Apnoea

Investigations

Abdominal X-ray

• Dilated bowel loops

• Pneumatosis intestinalis

• Portal venous gas

• Pneumoperitoneum

Management

• Stop feeds

• NG decompression

• IV fluids

• Antibiotics

• Surgical review

Complications

• Bowel perforation

• Strictures

• Short bowel syndrome

Common Exam Traps

Bloody stools + abdominal distension in a preterm infant = NEC until proven otherwise.

One Minute Revision

Prematurity + bloody stool + pneumatosis = NEC.

References

1. BAPM Guidance

2. Nelson Textbook of Pediatrics

3. Rennie & Roberton

Disclaimer

For educational and MRCPCH revision purposes only.