Necrotizing Enterocolitis: Diagnosis and Management

by Kevin Pei, MD

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    00:01 Welcome back.

    00:02 Thanks for joining me in this discussion of necrotizing enterocolitis in the section of pediatric surgery.

    00:09 Necrotizing enterocolitis is usually associated with premature babies and the onset of necrotizing enterocolitis (also called NEC) is usually after the first several weeks of life.

    00:24 Although there is an association with bottle-fed babies and that the symptoms occur generally after the first few feeds, babies who are not bottle-fed can certainly develop necrotizing enterocolitis as well.

    00:38 So, on the examination, don't be fooled if the patient is not bottle-fed.

    00:45 What are some physical findings of a baby who has potential NEC? Vomiting, diarrhea, perhaps abdominal distention, coupled with some wall erythema, although, note, an abdominal wall erythema is potentially a late finding.

    01:02 And sometimes babies have bloody stools.

    01:07 How does this baby look to you? Well, it's difficult to tell sometimes based on looking at the baby alone.

    01:14 Oftentimes, pediatricians will tell you babies who fail to thrive… again fail to thrive, meaning they're not progressing day by day as expected.

    01:24 If you look closely here in this picture, the baby has a little bit of erythema around the central abdomen.

    01:30 Abdominal distention is difficult to tell, particularly in a newborn.

    01:35 All of their abdomens look a little protuberant.

    01:38 Now, let's visit some specific findings.

    01:42 Babies who are noted to be apneic or have respiratory failure.

    01:46 These are also important findings in any baby who isn't doing well and has failure to thrive.

    01:53 Lethargy.

    01:56 Shock and hypotension.

    01:58 Again, much like abdominal wall erythema, shock and hypotension is potentially a late finding in NEC.

    02:06 And coagulopathy.

    02:09 This is very similar in adults who develop disseminated intravascular coagulopathy (DIC).

    02:19 What might you find on routine laboratory studies? Here, you see the chemistry shows a hyponatremia, potentially a low chloride, and in certain circumstances, decreases in the hemoglobin and hematocrit, particularly if the baby has hematochezia or bleeding per rectum.

    About the Lecture

    The lecture Necrotizing Enterocolitis: Diagnosis and Management by Kevin Pei, MD is from the course Special Surgery.

    Author of lecture Necrotizing Enterocolitis: Diagnosis and Management

     Kevin Pei, MD

    Kevin Pei, MD

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