Which clinical history is characteristic of necrotizing enterocolitis (NEC) in a premature baby?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Premature babies are at risk for developing necrotizing enterocolitis for several weeks after birth, with the age of onset inversely related to gestational age at birth.

Premature infants with patent ductus arteriosus are at higher risk for developing NEC earlier in life, particularly if they are treated with indomethacin for pharmacologic closure. However, patients with persistent patent ductus arteriosus who ultimately required surgical ligation were found to have a higher NEC-associated mortality rate than did patients whose patent ductus arteriosus was successfully closed without surgery.

Patients are typically advancing on enteral feedings or may have achieved full-volume feeds when symptoms develop.

Increased incidence in the posttransfusion period has been reported in otherwise healthy premature babies who are feeding enterally and undergo blood transfusion for asymptomatic anemia of prematurity.

Presenting symptoms may include subtle signs of feeding intolerance that progress over several hours to a day, subtle systemic signs that may be reported enigmatically by the nursing staff as "acting different," and, in advanced disease, a fulminant systemic collapse and consumption coagulopathy.

Symptoms of feeding intolerance can include abdominal distention/tenderness, delayed gastric emptying as evidenced by increasing gastric residuals, and, occasionally, vomiting.

Systemic symptoms can insidiously progress to include nonspecific signs and symptoms, such as increased apnea and bradycardia, lethargy, and temperature instability, among the primary manifestation(s).

Patients with fulminant NEC present with profound apnea, rapid cardiovascular and hemodynamic collapse, and shock.

The baby's feeding history can help increase the index of suspicion for early NEC. Babies who are breastfed have a lower incidence of NEC than do formula-fed babies.

Rapid advancement of formula feeding has been associated with an increased risk of NEC. [29] However, multiple subsequent studies have failed to substantiate this finding.


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