AKT · Child health/Neonatal & surgical

Necrotising enterocolitis

Bowel ischaemia + bacterial invasion (preterm gut)

Overview

Life-threatening inflammatory bowel necrosis chiefly of preterm/low-birth-weight neonates, often after enteral feeding. Bell staging guides management; pneumatosis intestinalis is the radiological hallmark.

Recognise

Feed intolerance, bilious vomiting/aspirates, abdominal distension and tenderness
Bloody stools
Systemic: lethargy, apnoea, temperature instability, shock

Red flags

Pneumoperitoneum (perforation), shock, abdominal wall erythema → urgent surgery

Differentials & how to tell them apart

Sepsis/ileusno pneumatosis on X-ray

Spontaneous intestinal perforationearlier, no pneumatosis, often isolated

Malrotation/volvulusbilious vomiting, upper-GI contrast shows abnormal DJ flexure

Investigations

Abdominal X-ray: pneumatosis intestinalis (intramural gas), portal venous gas, Rigler sign / free air if perforated. FBC (thrombocytopenia, neutropenia), CRP, blood gas, blood culture.

Management

Stop feeds, NG decompression, IV fluids + broad-spectrum antibiotics

1Medical: stop enteral feeds, NG tube on free drainage, IV fluids/TPN, broad-spectrum antibiotics, supportive care.Gate: Perforation (pneumoperitoneum) or clinical deterioration → urgent surgical laparotomy
2Surgery: resect necrotic bowel ± stoma.

Bowel rest + NG decompression + IV fluids — stop enteral feeds

Broad-spectrum IV antibiotics — cover Gram-negatives + anaerobes

Surgery — for perforation/necrosis

Key points

Breast milk and cautious feeding advancement reduce risk. Long-term: short-gut syndrome, strictures.

Monitor & prognosis

Serial abdominal X-rays/exam, gas, platelets/CRP, perfusion.

Significant mortality; survivors risk strictures/short gut.

Source: NICE NG; neonatal guidelines