What is the role of paracentesis 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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Answer

Ascites can develop during fulminant necrotizing enterocolitis and can compromise respiratory function. Paracentesis may be considered. This is most safely performed using ultrasonographic guidance. However, paracentesis is not without risks and should not be performed until a pediatric surgical consultation has been performed.

A positive finding on paracentesis with the free flow of at least 0.5 mL of brownish fluid that contains bacteria on Gram staining is highly specific for intestinal necrosis. A negative finding on paracentesis is uncommon with intestinal necrosis but may occur in the setting of a localized and walled-off perforation.

If no peritoneal fluid is aspirated, peritoneal lavage is performed with 30 mL/kg of isotonic sodium chloride solution, and the fluid is then suctioned.

Place an intra-abdominal drain as an alternative to laparotomy if the baby is not a surgical candidate (eg, in cases of extreme prematurity or cardiovascular collapse and shock).


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