Wednesday, May 02, 2007

Necrotizing Enterocolitis vs ........

Both babies were significantly small for dates -- about 1400-1500 grams (around 3 pounds) even though they were 34-35 weeks gestation. They were IUGR (intrauterine growth retardation) which is a significant risk factor for NEC (Necrotizing Enterocolitis).

Both presented the same way: Essentially normal vital signs, active bowel sounds, minimal residuals before feedings, no vomiting, no obvious blood in the stools. However, both had tight shiny bellies - potentially a symptom of NEC which can be lethal in these small infants.

We weren't overly worried, because we knew that even if this was NEC, we'd caught it early. The neonatologist ordered an xray and a CBC.

We get the xrays back first. Baby 1's xray was clearly benign -- full loops, but no pneumatosis (gas bubbles in the intestinal wall - a conclusive sign of NEC) . Diagnosis FOS*

Baby #2's xray was terrifying. It looked like virtually the entire colon had been impacted. The neonatologist headed off to phone the surgeon as I prepared to start an IV and give the ordered antibiotics. I opened the incubator portholes my nose told me there was another problem to deal with first.

I opened the stinky diaper and called the neonatologist over to examine the contents.

"No, it can't wait until after you call the surgeon. Just come look at this. Really, you want to see it before you make that call."

No. The diaper wasn't full of the feared "currant jelly" stool. Currant jelly stool is blood and mucous which is a sure indicator of intestinal bleeding and very commonly a surgical emergency. Instead, the stool looked almost exactly like the xray image of the intestine. It was frothy and full of bubbles. I don't remember what the final determination was on the frothy stool, but the baby definitely didn't have NEC. Again, diagnosis for that night was FOS*



*FOS - full of stool. Preemies often have sluggish GI motility and this FOS diagnosis isn't uncommon - but it's always a relief.

1 comment:

Bryan said...

In my clinic we would have referred to this as PID, or 'poop in dair'