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Necrotizing Enterocolitis



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Necrotizing Enterocolitis From ghoulies to ghosties and long leggety beasties things that go bump in the night good lord deliver us Bugs Drugs and Things that go Bump in the Night Old Cornish Prayer Caring for premature infant with NEC is like riding a mile high roller coaster without brakes All you can do is hang on for the ride and watch out for the bumps Epidemiology Pathophysiology Diagnosis Management Prevention RA Polin 2005 The Case Begins Baby M was a 1150 male infant 27 wk gestation born to a 26 year old woman Mrs M admitted to recreational use of cocaine Three days prior to delivery she was given indomethacin because of preterm labor The case continued The baby was delivered by emergency cesarean section because of late decelerations Apgar scores were 1 3 baby M required endotracheal intubation The case continued The case continued Because of worsening respiratory distress an umbilical arterial line was placed at L4 A CBC obtained from the UA was remarkable for a Hct 71 On day one of life the infant was placed on TPN The case continued The case continued Within 72 hours feedings were begun The baby was advanced to full feedings over 3 days On day 4 of life a murmur was heard and an echocardiogram and chest x ray were obtained Total fluid intake at that time was 185 ml kg day The case continued The case continued On day 10 of life he needed NaHCO3 because of a mild metabolic acidosis Gastric aspirates increased in volume and were blood tinged A CBC was remarkable for leukopenia and thrombocytopenia On day 11 he became distended developed erythema of the abdominal wall Epidemiology of NEC Affects 6 8 of VLBW infants Widely varying incidence between centers Incidence inversely related to degree of prematurity No seasonal or sex predilection racial effect Age at diagnosis is inversely related to gestational age and degree of prematurity Gestational age Age at onset 30 weeks 20 2 days 31 33 weeks 13 8 days 34 weeks 5 4 days Full term 1 3 days Vulnerable



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