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Updates in: Necrotising Enterocolitis - Abstract

Thakkar Hemanshoo, Lakhoo Kokila

 

Abstract

Necrotising Enterocolitis (NEC) is a neonatal surgical emergency with a high mortality. It is primarily seen in premature neonates with a low-birth weight and is characterised by intestinal ischaemia, infection and inflammation. The clinical features of NEC can be staged accordingly to Bell’s Classification (1978). Biochemical anomalies include an elevated CRP associated with thrombocytopaenia suggesting the presence of a necrotic process with consumptive coagulopathy. Plain abdominal radiography is usually sufficient in establishing the radiological diagnosis of NEC. There is however an emerging role for ultrasound scanning in predicting the need for intervention and identifying the “at-risk” neonate. Early management of NEC is usually conservative with a period of gut rest and intravenous antibiotics. The only absolute surgical indication to intervene is a perforation. However, relative indications for surgery include failure of medical management with increasing ventilatory requirements and/or haemodynamic support. The aims of surgery include resecting necrotic bowel whilst aiming to preserve intestinal length. An enterostomy is commonly fashioned as a means of diversion. A peritoneal drain may also be sited as a means of resuscitation prior to formal laparotomy. Mortality from NEC still remains between 30-40% despite several advances in neonatal care.

Keywords: NEC, Bell, USS, laparotomy, enterostomy, clip and drop

 

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