Necrotising Enterocolitis in Neonates - Guideline for the Management of
|Last review: 16/05/2019|
|Next review: 02/05/2022|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for the Management of Necrotising Enterocolitis in Neonates
Necrotising Enterocolitis in Neonates
Necrotising eneterocolitis (NEC) is seen primarily in preterm babies. Diagnosis depends on a constellation of signs. Rapid and adequate resuscitation should take place and close monitoring of fluid balance is vital. Non-antimicrobial measures alongside antibiotics are the mainstay of treatment. Surgical intervention is sometimes necessary both in the acute or recovery phases.
Remember, if infant is to be transferred to surgical unit, to ensure a sample of maternal blood for group and save is taken.
Empirical (initial) antimicrobial treatment
NEC is the most common gastrointestinal emergency occurring within the neonatal population. It occurs in 1-3 per 1000 live births and is most common in very low birth weight (VLBW) infants in whom the incidence rises to 6-7%.
NEC is characterised by ischaemic necrosis of the intestinal mucosa, which is associated with inflammation, invasion of enteric gas forming organisms and dissection of gas into the muscularis and portal venous system.1
NEC should be suspected in any infant with feed intolerance (increasing volume of aspirates or bilious aspirates) abdominal distension and bloody stools (or acute change in stools), however, the early signs can be much less specific (see table below) and it is important to remember that it does not only occur in premature infants.
Differential Diagnosis includes:
Diagnosis Staging modified from 2, 3,4
If umbilical lines in situ, do not remove unless discussed with senior colleague. Central access is often essential and this can necessitate the ongoing use of umbilical lines initially.
Early discussion with Paediatric surgical SpR is preferable in all cases of advanced NEC and should be considered in cases of proven NEC.
|Empirical Antimicrobial Treatment|
|Directed Antimicrobial Treatment (when microbiology results are known)|
Antimicrobials may be modified depending on Microbiology results, note documented bacteraemia in 20-30% of cases and pathogenic bacteria may be recovered from surgical specimen or peritoneal fluid.
|Duration of Treatment|
Duration: up to 14 days in confirmed cases of NEC
|Switch to oral agent(s)|
In infants failing to respond to treatment the infant requires senior review by both the medical and surgical teams and further consultation with microbiology.
Necrotising Enterocolitis (NEC)
|Target patient group:||Newborn infants who develop NEC|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
- Neu, J. Necrotizing enterocolitis: The search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996; 43:409. (c)
- Bell MJ. Neonatal necrotizing Enterocolitis. N Engl J Med. 1978 Feb 2;298(5):281-1. (B)
- Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing Enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978 Jan;187(1):1-7 [abstract]
- Walsh MC, Kleigman RM. Necrotizing Enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33:179 (C)
- Newell SJ. Gastrointestinal disorders. Roberton’s Textbook of Neonatology. Fourth Edition. (c)
- Michael J. Morowitz et al. Redefining the Role of Intestinal Microbes in the Pathogenesis of Necrotizing Enterocolitis. Pediatrics 2010;125:777-785 (c)
- C Rees, N Hall, S Eaton, and A. Pierro. Surgical strategies for necrotising enterocolitis: a survey of practice in the United Kingdom. Arch Dis Child Fetal Neonatal Ed. 2005 March; 90(2): F152F155
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Improving Antimicrobial Prescribing Group
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