Disorder affecting premature neonates, where part of the bowel becomes necrotic

Aetiology

• Serious intestinal injury to a relatively immature gut (e.g. premature baby being fed too early) resulting in perforation

Clinical features

• Intolerance to feeds
• Vomiting, particularly with green bile
• Generally unwell
• Distended, tender abdomen
• Absent bowel sounds
• Blood in stools

Investigations

• Bloods:
  • FBC: thrombocytopenia and neutropenia
  • CRP: inflammation
  • Capillary blood gas: metabolic acidosis
  • Blood culture: sepsis
• Abdominal x-ray:
  • Dilated loops of bowel
  • Bowel wall oedema
  • Gas in bowel wall
  • Gas in peritoneal cavity (pneumoperitoneum) indicates perforation

Management

• Nil by mouth with IV fluids and TPN
• Antibiotics to stabilise neonate: clindamycin and cefotaxime
• Immediate referral to the neonatal surgical team