What is the role of arterial blood gases in the workup of necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Depending on presentation acuity, hypoventilation and frank apnea are seen in necrotizing enterocolitis (NEC). Arterial blood gas (ABG) can aid in the determination of the infant's need for respiratory support. The ABG can also provide information of the acid-base status.

Acute acidosis is worrisome. Lactic acidosis results from decreased cardiac output (as in cardiovascular collapse and shock), leading to poor perfusion of peripheral tissues. Tissue necrosis may also add to the observed metabolic acidosis.

An arterial blood sample is a convenient way to simultaneously obtain a blood culture, CBC, serum electrolytes, and ABG for the initial evaluation (note that arterial blood has a lower yield for demonstrating bacteremia than does venous blood). Depending on presentation acuity, inserting a peripheral arterial line while peripheral perfusion and intravascular volume are still within the reference range may be prudent. This peripheral arterial line facilitates serial blood sampling and invasive blood pressure monitoring that is essential if the baby's condition deteriorates.

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