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Necrotizing Enterocolitis- NEC

NEC is a life threatening Gastrointestinal tract(GIT) emergence typically occur in 2nd to 3rd week of life in premature formula fed infants. It is characterized by variable damage to intestinal tract from mucosal injury to full thickness necrosis and perforation

The hallmark being invasion of the intestinal wall  by bacteria, causing local infection and inflammation that can ultimately destroy the wall of the intestine

The excessive inflammatory process initiated in the highly immunoreactive intestine in necrotizing enterocolitis extends the effects of the disease systemically, to affect distant organs such as the brain. Children with NEC are at increased risk for neurodevelopmental delays

Diagnostic Criteria

  • Abdominal distension or tenderness

  • Bile-stained vomit or bile-stained fluid up the nasogastric tube

  • Blood in the stools


  • FBP

  • Blood culture and sensitivity

  • CRP

  • Serum electrolytes

  • ABG analysis

  • Abdominal x ray AP and lateral decubitus view


Non pharmacological treatment

  • Stop oral feeds and start an IV infusion of dextrose saline

  • Pass a nasogastric tube (NGT) and leave it on free drainage (NGT for decompression)

  • Reintroduce expressed breastmilk feeds by NGT when the abdomen is soft and not tender, the baby is passing normal stools with no blood and not havin bilious vomiting. Starts feeds slowly and increase slowly by 1-2 ml per feed each day.

Pharmacological treatment

  • Give Dextrose 10%, 80ml/kg/24 hours

  • Give DNS 90ml/Kg/24 hours on the 2nd day then give fluids as shown in table 3.2.

  • Give Ampiclox IV 100mg/kg 12 hourly 14 days

  • Give Gentamicin IV 5mg/kg once daily 14 days

  • Give Metronidazole IV 7.5mg/kg 8 hourly 14 days


  • Refer to the next level with adequate expertise and facilities\

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Last updated on 23.08.2020


  1. Childrens hospital Los Angeles. Necrotizing enterocolitis. August 23.02.2020

  2. Tanzania standard treatment guideline edition 2017. page 54-55

  3. NCBI. NEcrotizing enterocolitis. August 23.2020

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