Medical Management of Necrotising Enterocolitis: The doctors role

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Medical Management of Necrotising Enterocolitis
The doctors role

• Dr J Preece
• Consultant Neonatologist
• Hull and East Yorkshire Womens Childrens
  Hospital

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NEC Aetiology in Preterm babies
Metabolic substrate (feeds)
Poor mucosal integrity with bacterial
colonisation and translocation
Hypoxia Ischaemia
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NEC Medical Management
Gut rest
Supportive Care
Infection control
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Principles of treatment

• Limit progression of disease
• Start treatment quickly
• Resuscitation
• Early antibiotics and gut rest
• Maintenance of systemic and mesenteric perfusion
• Physiological monitoring
• Regular review

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Resuscitation and Stabilisation

• Ventilation
• Respiratory failure
• Circulatory collapse
• Acidosis
• Diaphragmatic splinting
• Pain and analgesia
• Lines for monitoring
• UAC

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Ventilation

• Respiratory support
• (e.g. apnoea, analgesia)
• May only require low pressures
• Diaphragmatic splinting
• May require high pressures, longer inspiratory
  times and close monitoring
• Muscle relaxants?
• Volume guided?
• CPAP Vs intubation

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Gut Rest

• Stop feeds
• Nasogastric tube on free drainage
• Alternative nutrition
• Rest for 10 days

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Fluid Balance

• Resuscitation
• 10 mls/kg boluses
• Inotropic support
• Restoring intravascular volume
• Ongoing losses
• third space
• gastric
• Transfusions
• Maintenance fluids

• - N/saline or HAS 4.5
• - Dopamine and dobutamine
• - Up to 50 mls/kg initially
• - Further fluid boluses
• - 0.9 saline K

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Investigations

• Early
• Blood cultures
• Group Xmatch
• FBC, coagulation, biochemical profile
• Gases
• Radiological and laboratory monitoring for
  disease progression

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Analgesia

• Opiates
• Initial control of pain
• Analgesia and sedation
• Ongoing analgesia
• Intravenous paracetamol
• Low dose morphine

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Infection control

• Broad spectrum!
• Amoxicillin / gentamicin / metronidazole
• Cefotaxime / teicoplanin / metronidazole
• Meropenem / teicoplanin

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Yorkshire Region Guidelines for Neonatal
Stabilisation Prior to Transfer
Transfer Guidelines for Surgical Newborns
http//www.yorkshireneonet.org.uk/guidelines_folde
r/guidelines.htm
http//www.yorkshireneonet.org.uk/
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NEC Medical management
Gut Rest

• Stop feeds
• NG drainage

Infection control
Supportive Care

• Amoxicillin
• Gentamicin
• Metronidazole

• Ventilation
• Fluids and electrolytes
• Haemoglobin and clotting
• TPN