Necrotizing Enterocolitis

00:01 Welcome back.

00:02 Thanks for joining me in this discussion of necrotizing enterocolitis in the section of pediatric surgery.

00:09 Necrotizing enterocolitis is usually associated with premature babies and the onset of necrotizing enterocolitis (also called NEC) is usually after the first several weeks of life.

00:24 Although there is an association with bottle-fed babies and that the symptoms occur generally after the first few feeds, babies who are not bottle-fed can certainly develop necrotizing enterocolitis as well.

00:38 So, on the examination, don't be fooled if the patient is not bottle-fed.

00:45 What are some physical findings of a baby who has potential NEC? Vomiting, diarrhea, perhaps abdominal distention, coupled with some wall erythema, although, note, an abdominal wall erythema is potentially a late finding.

01:02 And sometimes babies have bloody stools.

01:07 How does this baby look to you? Well, it's difficult to tell sometimes based on looking at the baby alone.

01:14 Oftentimes, pediatricians will tell you babies who fail to thrive...

01:18 again fail to thrive, meaning they're not progressing day by day as expected.

01:24 If you look closely here in this picture, the baby has a little bit of erythema around the central abdomen.

01:30 Abdominal distention is difficult to tell, particularly in a newborn.

01:35 All of their abdomens look a little protuberant.

01:38 Now, let's visit some specific findings.

01:42 Babies who are noted to be apneic or have respiratory failure.

01:46 These are also important findings in any baby who isn't doing well and has failure to thrive.

01:53 Lethargy.

01:56 Shock and hypotension.

01:58 Again, much like abdominal wall erythema, shock and hypotension is potentially a late finding in NEC.

02:06 And coagulopathy.

02:09 This is very similar in adults who develop disseminated intravascular coagulopathy (DIC).

02:18 The Bell criteria are used to stage NEC into three categories.

02:22 Stage I is the mildest form, with non specific symptoms such as lethargy, unstable temperature, apnea, abdominal distention and vomiting.

02:30 Stage II is more severe and have absent bowel sounds and abdominal tenderness.

02:34 Stage III is the most severe and can encompass bowel perforation.

02:38 The slide has the full criteria that you can check out but you don't have to memorize them.

02:44 What might you find on routine laboratory studies? Here, you see the chemistry shows a hyponatremia, potentially a low chloride, and in certain circumstances, decreases in the hemoglobin and hematocrit, particularly if the baby has hematochezia or bleeding per rectum.