Necrotizing enterocolitis (staging)

Last revised by Dr Yusra Sheikh on 15 Nov 2019

Necrotizing enterocolitis (NEC) can be staged into three groups, to guide appropriate treatment based on the work of Bell et al. 1. In general, stage I and II are managed medically whereas stage III is managed surgically.

  • stage I
    • clinical signs
      • lethargy, temperature instability, apnea, bradycardia
      • emesis, abdominal distension, hematochezia
    • radiographic findings
      • intestinal dilatation
    • treatment
      • oral feeding cessation
      • parenteral nutrition
      • nasogastric tube suction
      • antibiotics
  • stage II
    • IIa: mildly ill
    • IIb: moderately ill
    • clinical signs
      • as in stage I
      • metabolic acidosis, thrombocytopenia
      • abdominal tenderness, absent bowel signs
    • radiographic findings
    • treatment
      • as in stage I
      • correction of metabolic acidosis
  • stage IIIa: shock
    • clinical signs
      • as in stage II
      • respiratory or circulatory arrest
    • radiographic findings
    • treatment
      • inotropes, etc.
      • as in stage II
  • stage IIIb: perforation
    • clinical signs: any
    • radiographic findings: pneumoperitoneum
    • treatment: surgery

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