NECROTIZING ENTEROCOLITIS SURGICAL CARE

Surgical Care of necrotizing enterocolitis :
Any patient requiring surgical intervention and many of those patients not progressing to surgery require protracted courses of parenteral nutrition and intravenous antibiotics.

o Secure central venous access is optimal for ensuring uninterrupted delivery of antibiotics and nutrition as well as maximizing nourishment with central venous formulations.

o Some units successfully use percutaneously inserted central venous catheters (PCVCs), while other units prefer surgically placed central lines such as Broviac catheters. Both types carry an increased risk of infection, particularly if they are used to administer lipids.

Consultations of necrotizing enterocolitis :
Consult with a pediatric surgeon at the earliest suspicion of developing NEC. This may require transferring the patient to another facility where such services are available.

Diet of necrotizing enterocolitis :
• When NEC is suspected, enteral feedings are withheld and parenteral nutrition is initiated. Centrally delivered formulations with maximal nutritional components are preferred. Enteral feedings can be restarted 10-14 days after findings on abdominal radiographs normalize in the case of nonsurgical NEC.

Reinitiating enteral feeds in postsurgical babies may take longer and may also depend on issues such as the extent of surgical resection, timing of reanastomosis, and preference of the consulting surgical team.

• Because of the high incidence of postsurgical strictures, some clinicians prefer to evaluate intestinal patency via contrast studies prior to initiating enteral feeds. When feeds are restarted, formulas containing casein hydrolysates, medium-chain triglycerides, and safflower/sunflower oils (Pregestimil/Nutramigen) may be better tolerated and absorbed than standard infant formulas.