Pediatric emergency medicine trisk 2551 2551

Infants with a history of bowel surgery can develop adhesions that present with
intestinal obstruction. This could include patients with a history of congenital
diaphragmatic hernia, omphalocele, gastroschisis, intestinal atresia, or meconium
syndrome, as well as patients with a history of NEC.

Necrotizing Enterocolitis
CLINICAL PEARLS AND PITFALLS
Although necrotizing enterocolitis (NEC) is most common in the
premature infant, up to 10% of cases occur in the term infant.
Term infants with NEC often have specific risk factors that increase the
risk of intestinal asphyxia or altered gut perfusion.
Infants with a history of NEC can present with small bowel obstruction
months after resolution of NEC.
Current Evidence
NEC is a gastrointestinal emergency where progressive mucosal injury and
inflammation result in bowel necrosis. While the incidence of NEC is inversely
proportional to gestational age, up to 10% of cases occur in the term neonate. Up
to a third of cases of NEC result in death, and postsurgical survivors have an
increased risk of developing short-bowel syndrome. While the exact etiology
remains unknown, elements of ischemic injury, intestinal hypoxia, coagulation
necrosis, acute or chronic inflammation, and bacterial overgrowth of the GI tract
are all likely contributors. Term infants with a history of intrauterine growth
restriction or SGA, congenital heart disease, meningomyelocele, and
gastroschisis have increased risk of developing NEC. Similarly, term and preterm
infants with a history of polycythemia, exchange transfusion, umbilical
catheterization or asphyxia, are also at increased risk of developing NEC.
Goals of Treatment
The primary goal of treatment is early recognition of NEC so that supportive
therapy can ameliorate bowel necrosis. Treatment includes fluid resuscitation and
blood pressure support, bowel rest, and broad-spectrum antibiotics that cover
enteric bacteria. Acidosis, anemia, and thrombocytopenia should be corrected.

Evidence of intestinal perforation (up to 50% of cases) requires surgical
intervention with either a drain procedure or laparotomy. Patients with necrotic
bowel may present without perforation but worsening abdominal discoloration