Necrotizing enterocolitis.

1. Big picture

Necrotizing enterocolitis (NEC) is one of the most dangerous gastrointestinal emergencies of the newborn, especially in preterm and very low birth weight infants.

The exam pattern is:

Preterm infant + enteral feeding + abdominal distension + feeding intolerance + bloody stool ± sepsis signs = think NEC.

The most classic investigation finding is:

Pneumatosis intestinalis — gas within the bowel wall.

NEC matters because it can rapidly progress to:

intestinal ischemia and necrosis
→ perforation
→ peritonitis
→ sepsis
→ shock
→ death

So management is urgent:

Stop feeds → decompress stomach → IV fluids/TPN → broad-spectrum antibiotics
→ serial abdominal exams/X-rays → surgery if perforation or deterioration

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