A neonate is suspected to be suffering from necrotizing enterocolitis (NEC). On further examination and investigation, he is diagnosed to he Bell's stage I NEC. The management of choice would be:
Ans. c. Conservative management with IV fluids and antibiotics (Ref: Nelson 19/e p601)The management of choice for Bell's Stage I necrotizing enterocolitis is conservative management with IV fluids and antibiotics.Treatment of Bell's Stage I Necrotizing Enterocolitis: NPO, IV fluids and Antibiotics for 3 days.A very preterm baby on 30 mL/kg of enteral feeding developed sudden severe abdominal distension with visible bowel loops on day 6 of life. The baby also showed temperature instability ami lethargy. X-ray of the abdomen showed portal venous gas. The staging of NEC is 2b.The severity, radiology and management of Necrotizing enterocolitis is best exemplified by the 'Modified Bell's staging criteria'. According to Modified Bell's staging criteria 'pneumatosis portalis (Presence of gas in portal vein) is suggestive of stage 2b.Modified Bell's Staging Criteria for Necrotizing EnterocolitisStageClassificationSystemicAbdominalRadiologicalTreatmentIASuspected NECTemperature instability, apnea, bradycardia, lethargyAspirates, mild abdominal distension, +ve fecalNormal/mild intestinal dilation/mild ileus, occult bloodNPO, IV fluidsAntibiotics x 3 daysIBSuspected NECSame as IAFresh blood per rectumSame as IASame as IAIIAProven NEC, mildly illSame as IASame as IA+ absent bowel sounds +- abdominal tendernessIntestinal dilation, ileus, pneumatosis intestinalisQNPO, Antibiotics x 7-10 daysMBProven NEC, moderately illSame as IA + mild metabolic acidosis + mild thrombocytopeniaSame as IA + absent bowel sounds, definite tendernessQ, abdominal cellulitis, right lower quadrant massSame as IIA + portal venous gasQ +- ascitesNPO, Antibiotics x 14 daysIMAAdvanced NEC, severely illQ,bowel intactSame as IIB + hypotension, respiratory acidosis, neutropenia, DICSame as IIB + suggestive of peritonitis, marked abdominal tenderness, marked abdominal distentionSame as IIA + definite ascitesQNPO,Antibiotics x 14 days Fluid resuscitation ionotropic support ventilator therapy ParacentesisIIIBAdvanced NEC, severely ill, bowel perforatedQSame as IIIASame as IIIASame as IIB + pneumoperitoneumQSame as IIIA + surgery
Laparotomy and proceed
Insertion of bilateral pelvic drains
Conservative management with IV fluids and antibiotics
Initial conservative management and laparotomy after 24 hours
Stomach and Intestines