Neonatal Necrotizing Enterocolitis NEC:Management,Prognosis,Complications

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Neonatology in Children

Neonatal Necrotizing Enterocolitis(NEC)

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Results

NEONATAL NECROTIZING ENTEROCOLITIS (NEC)

Related topics

Neonatal Necrotizing Enterocolitis(NEC)

Pathogenesis,Pathology and Clinical Features

Clinical Staging and Investigations

Prevention and Differential Diagnosis

Ira Shah
Medical Sciences Department, Pediatric Oncall,
Mumbai

MANAGEMENT :

Medical

Surgical

Respiratory :

Supplement O 2
Mechanical ventilatory support

CVS :

Fresh frozen plasma
Low doses dopamine

Metabolic :

NaHCO

Nutrition :

Stop oral feedings (7-14 days)
TPN instituted (90-110 cal/kg/d)

Antibiotics - For 7-14 days. Broad spectrum

Hematological :

Platelet transfusions
Packed RBCs
Vitamin K

CNS :

Treat IVH, meningitis, Seizures

Renal :

Fluid therapy

Indications :

Bowel perforation
Full thickness necrosis of bowel wall as evidenced by dilated loop of intestine unchanged in position > 24 hrs.
Peritonitis. Aspiration of brown colored fluid is indicative of intestinal gangrene.

Surgical treatment :
Excision of necrotic area & end-to-end anastomosis.

PROGNOSIS :

Recurrent NEC is 4%.

Sequelae :

Strictures (20%) most common in large bowel
Enteric fistulas
Short bowel syndrome (following surgery)
Malabsorption & chronic diarrhea
Dumping syndromes - loss of terminal ileum
Fluids electrolyte losses (with ileostomy)
Parenteral nutrition associated hepatic disease
Developmental delay.

Next : Prevention and Differential Diagnosis

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