How is it Diagnosed?
Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition primarily affecting
premature neonates. Diagnosis is based on a combination of clinical signs, radiologic
findings, and laboratory results. Clinically, infants may present with abdominal
distension, feeding intolerance, bloody stools, lethargy, apnea, and temperature
instability. A thorough history, especially noting prematurity and enteral feeding
practices, is crucial.
The definitive diagnosis involves abdominal radiography, which may reveal hallmark
signs such as pneumatosis intestinalis (gas within the intestinal wall), portal venous gas,
or in advanced cases, free intraperitoneal air indicating intestinal perforation. Serial Xrays help track disease progression. Ultrasound may also be used to detect bowel wall
thickening, free fluid, and decreased bowel perfusion.
Laboratory investigations typically show nonspecific signs of inflammation and
infection such as elevated C-reactive protein (CRP), leukocytosis or leukopenia,
thrombocytopenia, and metabolic acidosis. Blood cultures are important to identify
sepsis, often associated with NEC.
Early diagnosis and intervention are critical. NEC is staged using Bell’s criteria, which
guide clinical decisions based on severity. A multidisciplinary approach involving
neonatologists, radiologists, and pediatric surgeons is essential for accurate diagnosis
and management.