Overview

• Disorder affecting premature neonates, in which part of the bowel becomes necrotic.
  • Inflammation and necrosis of the bowel wall.
• Risk Factors → low birth weight, prematurity (MAIN RF), formula feeds.

Making Diagnosis

Clinical Features

• Feeding intolerance.
• Abdominal distension.
• Bloody stools.
• Vomiting (with green bile).
• Perforation → peritonitis + shock.

Investigations

• Abdominal X-Ray → dilated bowel loops, bowel wall oedema, pneumatosis intestinalis (intramural gas), pneumoperitoneum (if perforation - may be associated with Rigler sign).
• Bloods → FBC (thrombocytopenia, neutropenia), CRP (inflammation), CBG (metabolic acidosis), blood culture (sepsis).

Management Plan

• Medical → NBM, IV Fluids, TPN (bowel rest), and broad-spectrum antibiotics (cefotaxime/tazocin and vancomycin) .
  • NG Tube to drain fluid and gas from stomach and intestines (decompress the bowel).
• Surgical → if perforation or failure to respond to medical treatment. Laparotomy with resection of necrosed bowel.