Evidence-Based Care for the Infant With Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is an inflammatory bowel disease that affects primarily preterm infants. Presenting symptoms can be insidious, including mild feeding intolerance apnea and bradycardia episodes, or catastrophic resulting in cardiovascular collapse, bowel ischemia, and death. Diagnosis is based on clinical and roentgenogram findings with or without hematologic markers. Prevention of NEC or prediction of disease remains elusive, but emerging evidence for the use of breast milk (mother's own or donor milk) and prophylactic probiotics are promising therapies for future exploration. Treatment of NEC varies between institutions but usually includes bowel rest, antibiotics, and ongoing assessment for disease progression. Controversy regarding antibiotic choice, pain management, role of parents in decision making, and indications for surgery prevent clear standardized evidence-based guidelines. Clinicians must base decisions on the best available evidence and an understanding of the disease process. This article presents a clinical scenario that highlights many questions regarding the care of the infant with NEC. A brief discussion of the pathophysiology of NEC as well as signs and symptoms of disease, risk factors for development, and prognosis will be presented. Preventative measures will be discussed. The case study will be used as a framework for examining treatment options, using the best available evidence. Issues of pain management, antibiotic coverage, ongoing assessment, and parental roles will be explored. Practice guidelines will be provided and areas for future research will be proposed.