NEC

Risk Factors

100

Name one risk factor for NEC, besides prematurity 

Low Birth Weight 

200

This risk factor's awareness month is celebrated in February 

CHD (congenital heart disease)

300

This risk factor is associated with antibiotics 

Sepsis 

400

90% of cases of NEC occur in this population

What is VLBW infants born < 32 weeks

500

True or False: Hyperosmolar feedings increase the risk of NEC

True

Clinical Manifestations

100

Name 3 clinical Gi findings, suspicious for NEC

1. abdominal distention

2. bloody stools 

3. emesis

200

Name 2 respiratory clinical manifestations of NEC 

1. apnea 

2. respiratory acidosis 

300

These findings on an XR make you concerned for NEC

Abnormal gas pattern, dialated loops, and thickened bowel wall 

400

Gas cysts in the bowel wall

What is pneumatosis intestinalis 

500

Free air in the abdominal cavity 

pneumoperitoneum

Bell Staging

100

A baby is noted to have increased apnea/bradycardic episodes overnight. The nurse also tells you that he had a stool that looked bloody. On your exam you feel like the baby's abdomen is more distended but still soft. Baby's ABG is shows pH 7.3, CO2 55. Does this baby have NEC?

Yes, Stage 1 (Bell Staging)

200

Baby is noted to have increased A/B overnight with no increased WOB. Abdominal exam is unremarkable. Should you get a KUB? 

Not necessarily, not concerning for NEC

300

A baby is having more A/B overnight, the nurse tells you the baby's abdomen is tender, pH 7.24, CO2 33, XR shows pneumatosis. What else might you find on labs?

thrombocytopenia 

Bell Stage 2 NEC 

400

A baby w/ A/B episodes, metabolic and respiratory acidosis, pneumatosis intestinalis suddenly develops hypotension. What new finding might you see on KUB?  that would suggest stage 3 NEC 

pneumoperitoneum

500

How is Stage 2 NEC managed 

Medically 

Treatment

100

This is the first thing you do if you suspect your baby has NEC 

NPO (Stop feeds)

200

A baby has stage 2 NEC, what is the management of this

NPO 

Empiric antibiotics

Serial abdominal exams

300

This is an absolute indication for surgery 

penumoperitoneum

400

This is used while a baby is receiving bowel rest 

TPN

500

You see pneumatosis intestinalis on KUB. What should you do next?

manage medically: NPO, antibiotics, serial abdominal exams 

Misc

100

Reduces the incidence of NEC

What is breastmilk

200

what antibiotics are used in NEC

Ampicillin

Gentamicin

Metronidazole

300

Duration of antibiotic therapy

2 weeks

400

what does a football sign mean on XR?

Seen with massive pneumoperitoneum 

In supine position air collects anterior to abdominal viscera 

500

most common portion of GI tract affected by NEC 

Terminal ileum and colon