|
Clinical Diagnosis
|
Stage
|
|
no evidence of NEC
|
0
|
|
NEC suspected
|
I
|
|
definite NEC
|
II
|
|
advanced NEC
|
III
|
General features shared by all stages:
(1) one or more historical factors associated with neonatal stress
(2) exclusion of other causes of gastrointestinal disease in neonates (malrotation, atresia, volvulus, Hirschsprung's disease, etc.)
Historical factors associated with NEC:
(1) small for gestational age or premature delivery
(2) pulmonary disease
(3) cardiopulmonary instability
(4) abnormal labor and delivery
(5) multiple births
(6) maternal and/or neonatal infection
(7) umbilical catheter
(8) exchange transfusion
Parameters:
(1) systemic manifestations
(2) gastrointestinal manifestations
(3) radiographic findings
|
Manifestations
|
Stage I
|
Stage II
|
Stage III
|
|
systemic
|
temperature instability, lethargy, apnea, bradycardia
|
|
deteriorating vital signs, septic shock
|
|
gastrointestinal
|
poor feeding, increasing pregavage residuals, emesis, mild abdominal distension, occult blood in stool or emesis
|
persistent occult blood or gross GI bleeding, abdominal distension
|
massive GI bleeding
|
|
radiographic findings
|
intestinal distension with mild ileus
|
intestinal distension with more marked ileus, edema of bowel wall, "rigid" bowel loops, portal vein gas, pneumatosis intestinalis
|
pneumo-peritoneum
|
