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Necrotizing Enterocolitis and Neonatal Sepsis Diagnosis Management Guide
Frequently Asked Questions
What is necrotizing enterocolitis (NEC)?
Necrotizing enterocolitis (NEC) is a serious gastrointestinal emergency in newborns, especially preterm infants, characterized by inflammation, bacterial invasion, and necrosis of the intestinal wall, which may lead to perforation.
Which babies are at highest risk for NEC?
The highest risk is in premature infants (<32 weeks), very low birth weight babies (<1500 g), formula-fed infants, and those with hypoxia, sepsis, or patent ductus arteriosus (PDA).
What is the hallmark radiological sign of NEC?
The hallmark radiological sign is pneumatosis intestinalis, which means air within the bowel wall. Other severe signs include portal venous gas and pneumoperitoneum.
What are the common symptoms of NEC?
Common symptoms include feeding intolerance, abdominal distension, vomiting, bloody stools, lethargy, apnea, bradycardia, and signs of shock in severe cases.
How is NEC managed initially?
Initial management includes stopping feeds (NPO), nasogastric decompression, IV fluids, parenteral nutrition, broad-spectrum antibiotics, and close monitoring in the NICU.
When is surgery required in NEC?
Surgery is required if there is bowel perforation (free air), necrotic bowel, peritonitis, or clinical deterioration despite maximal medical therapy.
What are the major complications of NEC?
Major complications include bowel perforation, peritonitis, strictures, short bowel syndrome, neurodevelopmental impairment, and death.
How can NEC be prevented?
Prevention includes exclusive breast milk feeding, cautious advancement of feeds, probiotics in selected NICUs, and minimizing unnecessary antibiotic exposure.
What is neonatal sepsis?
Neonatal sepsis is a systemic infection in newborns within the first 28 days of life, caused by bacteria or fungi invading the bloodstream, potentially leading to septic shock and organ dysfunction.
What is the difference between early-onset and late-onset neonatal sepsis?
Early-onset sepsis occurs within 72 hours of birth and is usually acquired from the mother (GBS, E. coli). Late-onset sepsis occurs after 72 hours and is often hospital-acquired (CoNS, Klebsiella, Candida).
What are the common signs of neonatal sepsis?
Signs are nonspecific and include poor feeding, lethargy, apnea, temperature instability, respiratory distress, hypotension, shock, seizures, and jaundice.
What is the gold standard test for neonatal sepsis?
The gold standard is a blood culture. Additional supportive tests include CBC, CRP, procalcitonin, and lumbar puncture if meningitis is suspected.
What antibiotics are used for empiric treatment of early-onset sepsis?
Empiric treatment typically includes ampicillin plus gentamicin to cover Group B Streptococcus, Listeria, and Gram-negative organisms.
What antibiotics are commonly used for late-onset sepsis?
Late-onset sepsis often requires vancomycin for CoNS/MRSA coverage plus a broad Gram-negative agent depending on NICU protocols.
What are the complications of neonatal sepsis?
Complications include septic shock, disseminated intravascular coagulation (DIC), meningitis, neurodevelopmental delay, NEC, multi-organ failure, and death.
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