Time of Onset Necrotizing Enterocolitis: When We Should be Aware (original) (raw)

Necrotizing enterocolitis (NEC) is a gastrointestinal emergency commonly encountered in neonatal intensive care units, with an incidence of 1-5 per 1000 live births. Prematurity and formula feeding remain as major independent predictors for NEC, and in regards of that, NEC occurs in approximately 10% of preterm neonates [1-3]. Based on its management, NEC in premature infants is divided into two, namely medical and surgical NEC. Medical management of NEC (mNEC) includes stopping all enteral feedings, performing gastric decompression, and intravenous broad-spectrum antibiotics. On the other hand, in surgical NEC (sNEC) cases, estimated in 20-40% of cases, requiring surgical intervention, in which management geared to control sepsis and to remove the necrotic bowel and performs an ileostomy or anastomosis [1,4]. Necrotizing enterocolitis diagnosis is generally established using Bell's modification criteria, including systemic and laboratory, abdominal, and radiographic signs and parameters. Currently, pneumoperitoneum and worsening of clinical condition after optimum medical therapy, namely Bell stage III, are the most common indications for surgery [4,5]. However, Bell's criteria itself is still less sensitive and specific for early diagnosis and detection based on the clinical characteristics of medical and surgical NEC [6]. Early recognition of (NEC) requiring surgery and those who may recover with medical