What are the initial treatment options for Bell stage I or II 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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The mainstay of treatment for patients with stage I or II necrotizing enterocolitis (NEC) is nonoperative management. The initial course of treatment consists of stopping enteral feedings, performing nasogastric decompression, and initiating broad-spectrum antibiotics. Historically, antibiotic coverage has consisted of ampicillin, gentamicin, and either clindamycin or metronidazole, although the specific regimen used should be tailored to the most common nosocomial organisms found in the particular neonatal intensive care unit.

Authors in some series have proposed the use of enteral aminoglycosides for the treatment of NEC, but several prospective trials have shown no efficacy for this treatment. In addition, a strong index of suspicion for fungal septicemia must be maintained, especially in the infant with a deteriorating condition and negative bacterial cultures.

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