Necrotising Enterocolitis

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Necrotising Enterocolitis

• Anne Aspin 2005

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What is it?

• Infection of the mucosal lining of the bowel
• Lactobacilli
• Clostridium
• Unknown

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Who does it effect?

• Maternal factors
• prematurity
• Hypoxic episodes
• Cardiac anomaly
• Exchange transfusion
• Umbilical line near mesenteric artery
• High osmolarity feeding
• Increasing feeds quickly

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Signs and symptoms

• Change in behaviour
• Subtle signs
• Lethargy
• Increasing naso-gastric aspirates
• Labile temperature, labile blood sugars
• Vomiting, bile later
• Blood in stools
• Abdominal distension

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Later

• Mottled, grey, capillary refill lt4 secs
• Apnoeic
• Bradycardia
• Oxygen requirement
• Abdominal tenderness
• Oedema
• Dilated abdominal veins, dilated loops of bowel
• Flare around umbilicus

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Even later

• Thrombocytopenia
• Raised CRP
• Pneumoperitoneum
• Collapse, ventilation
• Abdominal drain
• Surgery, stomas
• Short bowel

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Grading

• Grade 1
• Grade 2
• Grade 3
• Grade 4

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What to do

• Large ng tube, aspirate and free drainage
• Nil by mouth
• IVI, Antibiotics
• Blood sugar monitoring
• Sepsis screen. Blood gas, FBC, U/Es, Blood
  cultures
• Urine MC/S, CXR, AXR

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Surgical intervention

• When perforated
• When conservative treatment failing
• Strictures, adhesions

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Stoma

• Immediate post-op
• Stoma care
• Stomal complications

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Enteral feeding

• Feeding
• Long term TPN
• Short bowel