Chapter 17
THE SURGICAL NEONATE
Marjorie J. Arca, MD(^) I. NECROTIZING ENTEROCOLITIS
Necrotizing enterocolitis (NEC) is bacterial infection of the intestine in a
neonate, Its involvement vary from a limited segment of intestine to “NEC
totalis”, including all of the midgut and colon. It is a major cause of morbidity &
mortality among premature infants, especially those with a birth weight ≤ 1500
grams. It is seen in infants who have received enteral feeds. Major risk factors
include prematurity, use of indomethacin, presence of UAC, UVC, enteral
feeds, intrapartum cocaine exposure.
Symptoms may occur suddenly or insidiously. Early symptoms may
include delayed gastric emptying (gastric residuals, bilious residuals). Other
symptoms include abdominal distention. Signs on examination include
abdominal tenderness, abdominal discoloration. Lab data may include
thrombocytopenia, acidosis, glucose instability.
NEC Stages
(Walsh & Kliegman’s modification of Bell’s Criteria)
(^) Stage I (suspect NEC)
Suggestive clinical signs & symptoms but radiographs non-diagnostic
Stage II (definite NEC)
Abdominal XStage IIA: mildly ill, or-ray findings of pneumatosis, plus