THE SUPERIOR UNIVERSITY
DEPARTMENT OF NURSING
Topic: Necrotizing enterocolitis
Subject: Pediatric Health Nursing
Submitted to: Madam Zunaira Khadam
Submitted by : Waqas Ahmad
Objectives
At the end of this presentation, we all will be able to gain knowledge
and understanding about NEC;
◦Introduce & Define NEC
◦Describe the Incidence and Prevalence
◦Discuss the Etiology of NEC
◦Explain the Pathophysiology of NEC
◦• Enlist the Clinical Manifestation
◦• Elaborate the, Diagnosis, Treatment and prevention of NEC
Contents
Sr No Content
1 Introduction & Definition of NEC
2 Epidemiology
3 Risk Factors
4 Etiology of NEC
5 Clinical features
6 Pathophysiology
7 Diagnosis
8 Treatment
9 Nursing management
10 Complications
11 Prognosis
Introduction
◦Necrotizing enterocolitis is an acute inflammatory disease of the
bowel increased incidence in preterm infants. The precise cause
of NEC is still uncertain, but it appears to occur in infants whose
gastro intestinal tracts have experienced vascular compromise.
Intestinal ischemia of unknown etiology, immature gastrointestinal
host defenses, bacterial proliferation, and feeding substrate are now
believed to have a multifactorial role in the etiology of NEC.
Prematurity remains the most prominent risk factor in the
development of NEC.
Definition
Necrotizing: means tissue is dying.
◦Enterocolitis: means inflammation in the intestines (small and
large).
So, NEC is a serious inflammation in a baby’s intestines that can
damage and even kill tissue. It’s especially dangerous for premature
babies.
Epidemiology
Most common Gl emergency in newborns
Incidence 3 per 1000 live births
Incidence is 30 per 1000 live births for low birth weight neonates
90% are premature
Incidence is 7% in newborns <1500
◦Race: blacks > non-Hispanic whites
Risk Factors
Prematurity (<34 weeks)
Low birth weight (<1500g)
Occurs in 2-10% of neonates <1500g
Enteral feeding of premature infants
Hypertonic formula
Breast milk protective compared to formula
◦Term infant with pre-existing illness
Etiology of NEC
◦The exact cause is unknown, but factors like immature gut, formula
feeding, and bacterial infections are implicated.
◦These premature infants have immature bowels, weakened by too
little oxygen or blood flow. So when feedings are started, the added
stress of food moving through the intestine allows bacteria
normally found in the intestine to invade and damage the wall of
the intestinal tissues. The damage may affect only a short segment
of the intestine or can progress quickly to involve a much larger
portion.
Clinical features
Abdominal distention
Blood in the stool
Diarrhea
Feeding intolerance
Lethargy
Temperature instability
◦Vomiting
Pathophysiology of NEC
Diagnosis
Abdominal X-ray
Stool for occult blood test
Elevated white blood cell count in a CBC
Thrombocytopenia (low platelet count)
◦Lactic acidosis
Treatment
Intravenous fluid replaces formula or breast milk.
Antibiotic therapy is started.
The infant’s condition is monitored with abdominal x-rays, blood tests, and blood
gases.
Surgery will be needed if there is a hole in the intestines or peritonitis
(inflammation of the abdominal wall).
The dead bowel tissue is removed and a colostomy or ileostomy is performed.
◦The bowel is then reconnected several weeks or months later when the infection
and inflammation have healed.
Nursing management
NPO (nothing by mouth): Feedings are stopped to allow the bowel to
rest and heal.
Total parenteral nutrition (TPN): Nutrients are delivered
intravenously to meet the baby’s nutritional needs.
◦Human milk: Breast milk is preferred over formula due to its
immunological and gut-protective properties.
◦Fluid and Electrolyte Management
◦Monitoring vital signs
Complications
Intestinal perforation
Intestinal stricture
Peritonitis
◦Sepsis
Prognosis
◦Depends on the severity of the illness.
◦Most infants who develop NEC recover fully and do not have
further feeding problems.
◦Another residual problem may be malabsorption (the inability of
the bowel to absorb nutrients normally). This is more common in
children who required surgery for NEC and had part of their
intestine removed.
References
◦ Wong's Book page no 236 necrotizing enterocolitis
◦ https://kidshealth.org/en/parents/nec.html
◦ https://emedicine.medscape.com/article/977956-overview
◦ https://consultqd.clevelandclinic.org/preventing-necrotizing-enterocolitis-
maintaining-growth-vlbw-infants/
