Clinical Management of Necrotising Enterocolitis

Necrotising enterocolitis is a clinical diagnosis. The presenting history, examination findings and investigations are all important in making the diagnosis of NEC. In clinical practice many babies with early disease (Bell stage I or equivalent) may be indistinguishable from other diagnoses in preterm infants. These babies should be treated as NEC and reviewed after 48 h when the diagnosis often becomes clearer. Babies with confirmed NEC require medical management for a period of 7–10 days and may require surgery. Babies with NEC will typically have systemic upset, abdominal distension and bilious aspirates. They may have blood in their stools. In the presence of such symptoms, pneumotosis intestinalis on x-ray or ultrasound scan confirms the diagnosis. Medical treatment for NEC remains supportative only with babies receiving gut rest and decompression and broad-spectrum antibiotics. Some infants will develop multi-organ failure and require ventilatory and cardiovascular support. Babies who are successfully treated for NEC may go on to develop intestinal strictures.