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.