Necrotizing enterocolitis (NEC) is a severe neonatal disease characterized by clinical features such as abdominal distension and fullness, vomiting, hematochezia, and shock, accompanied by radiographic findings of intestinal gas accumulation, fixed intestinal loops, and pneumatosis intestinalis on abdominal X-ray. It is commonly seen in premature infants and low birth weight infants.

bubble_chart Diagnosis

(1) Medical history: Common causes include asphyxia, exchange transfusion, severe hypoxia due to pulmonary hyaline membrane disease, artificial feeding with hypertonic milk, polycythemia, intestinal infection, or sepsis. (2) Clinical manifestations: Early symptoms include pallor, drowsiness, stomach distension disease, abdominal distension and fullness, vomiting, hematochezia, or occult blood in stool, with weakened or absent borborygmi. In severe cases, infants may experience hypothermia and shock. (3) Abdominal X-ray: Findings vary with disease severity, including intestinal gas accumulation, fixed dilated intestinal loops, foamy cystic pneumatosis of the intestinal wall, and portal venous gas. Pneumoperitoneum may occur in cases of intestinal perforation.

bubble_chart Treatment Measures

﹝Treatment﹞

(1) Fasting Generally, fasting is required immediately for about 5 to 10 days until abdominal distension and fullness disappear. Oral feeding can be attempted when occult blood in the stool turns negative. If abdominal distension and fullness and vomiting recur after eating, fasting should be resumed until symptoms disappear before restarting feeding. (2) When abdominal distension and fullness is severe, gastrointestinal decompression is necessary. (3) Fluid replacement and correction of acidosis The total fluid volume should be approximately 120–150 ml/kg per day. Acidosis is usually present in affected children, and 3–5 ml/kg of 5% sodium bicarbonate can be administered each time, adjusted as needed based on BE calculation. For those undergoing gastrointestinal decompression, sodium-containing fluids can be supplemented with normal saline. Blood sodium, chloride, and potassium levels should be promptly measured to adjust the infusion composition. Caloric intake should be maintained at least at 50 kcal/kg per day, gradually increasing to 100–120 kcal/(kg·d) as appropriate. In addition to 10% glucose, protein can be supplied via plasma transfusion or compound formula amino acid solution. To increase caloric intake, intralipid should also be administered. Attention should be paid to supplementing trace elements and multivitamins. Total parenteral nutrition via central venous access is preferable, though most children can be maintained with peripheral venous access. When resuming oral feeding, glucose water should be given first, followed by diluted milk, with gradual increases in milk volume and concentration. (4) Anti-infection therapy Typically, intravenous ampicillin and gentamicin are used, with third-generation cephalosporins administered if necessary. Antibiotics should be adjusted based on culture and sensitivity results. (5) Symptomatic treatment For severe cases with shock, 10% low-molecular-weight dextran at 10 ml/kg can be administered, along with plasma or blood transfusion. Hydrocortisone at 10–20 mg/kg every 6 hours may also be given. (6) If surgical conditions are suspected, early consultation and exploratory laparotomy should be performed. Necrotic bowel segments require resection.