Necrotising Enterocolitis

Necrotising enterocolitis is acute inflammatory and ischaemic injury of the neonatal intestine, predominantly affecting premature infants. Disease may progress from feeding intolerance to transmural necrosis, perforation, sepsis and death.

• Feeding intolerance
• Increasing gastric residuals
• Abdominal distension
• Bilious vomiting
• Bloody stool
• Abdominal tenderness
• Apnoea and bradycardia
• Temperature instability
• Shock

Abdominal wall erythema, peritonism or a fixed abdominal mass suggests advanced disease.

Abdominal radiography may show:

• Dilated bowel loops
• Pneumatosis intestinalis
• Portal venous gas
• Pneumoperitoneum with perforation

Check FBC, platelets, blood gas, lactate, electrolytes and cultures.

• Stop enteral feeds immediately.

• Insert nasogastric or orogastric tube for decompression.

• Provide IV fluids and parenteral nutrition when prolonged bowel rest is required.

• Start broad spectrum IV antibiotics covering Gram positive, Gram negative and anaerobic organisms.

• If a standard neonatal sepsis regimen is being used, add anaerobic cover such as metronidazole when NEC is suspected.

• Obtain urgent paediatric surgical assessment for perforation, necrotic bowel, worsening acidosis or clinical deterioration despite medical treatment.