Necrotizing enterocolitis (staging)

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Necrotizing enterocolitis (NEC) can be staged into three groups, to guide appropriate treatment based on the work of Bell et al. . In general, stage I and II are managed medically whereas stage III is managed surgically.

stage I
- clinical signs
  - lethargy, temperature instability, apnea, bradycardia
  - emesis, abdominal distension, hematochezia
- radiographic findings
  - intestinal dilatation
- treatment
  - oral feeding cessation
  - parenteral nutrition
  - nasogastric tube suction
  - antibiotics
stage II
- IIa: mildly ill
- IIb: moderately ill
- clinical signs
  - as in stage I
  - metabolic acidosis, thrombocytopenia
  - abdominal tenderness, absent bowel signs
- radiographic findings
  - intestinal dilatation
  - portal venous gas
  - pneumatosis intestinalis
- treatment
  - as in stage I
  - correction of metabolic acidosis
stage IIIa: shock
- clinical signs
  - as in stage II
  - respiratory or circulatory arrest
- radiographic findings
  - as in stage II
  - ascites
- treatment
  - inotropes, etc.
  - as in stage II
stage IIIb: perforation
- clinical signs: any
- radiographic findings: pneumoperitoneum
- treatment: surgery