0071643192.pdf

PEDIATRICS

■ If the infant has been vomiting for a few days, serum chemistries will

reveal the classic hyponatremic, hypochloremic, hypokalemic metabolic

alkalosis.

TREATMENT

■ IV fluid resuscitation

■ Electrolyte repletion

■ Surgical consultation

COMPLICATIONS

■ Weight loss

■ Dehydration

■ Electrolyte abnormalities

NECROTIZINGENTEROCOLITIS(NEC)

NEC occurs due to bacterial overgrowth in the bowel, with translocation of

bacteria into the bowel wall and the production of bacterial endotoxin and

gas. A combination of factors is thought to predispose an infant to NEC,

including:

■ Prematurity

■ Ischemia, with perfusion-reperfusion injury to the bowel

■ Infection

■ Introduction of parenteral feeding

■ Reduced immune response

Infants typically develop NEC in the first few days of life, but NEC can

appear as late as 1 month of age. The terminal ileum is affected most com-

monly, followed by the colon.

SYMPTOMS/EXAM

■ Abdominal distention

■ Nonbilious emesis

■ Grossly bloody or guaiac positive stools

■ Sepsis (lethargy, temperature instability, apnea, bradycardia)

■ Abdominal wall erythema and firm loops of bowel (if bowel necrosis develops)

DIAGNOSIS

■ AXR radiograph may demonstrate pneumatosis intestinalis (gas in the

wall of the bowel) or portal venous air (see Figure 5.17).

■ Pneumoperitoneum may be present if perforation has occured.

■ Labs: May see evidence of DIC (thrombocytopenia, elevated INR), hypona-

tremia, and metabolic acidosis

TREATMENT

■ NPO

■ IV fluid resuscitation

■ IV antibiotics

■ NG tube

■ Surgical consultation; emergent bowel resection is required only if bowel

is necrotic or perforated.