[lccougar02]

Hey everyone,
I just took care of a 29 weeker yesterday. Her apgars were 2-4-6 at birth. She was doing well for my 8 hour shift and I came onto the unit today and they said she has suspected NEC. They said her stomach perferated from the OG tube. Can that really happen? i took care of her for 8 hours and saw no signs of NEC...why so sudden? Was it something I did?
~Jackie

[fergus51]

A stomach can perforate from an OG, but that isn't NEC. NEC affects the intestines (it's the inflammation/infection of the bowel). While the exact cause is unknown, it isn't something the nurse did. It just happens. Several theories exist as to why (most docs I know will tell parents that the baby's gut is just immature and can't handle feedings, it is also thought that intestines that have been hypoxic for a while just can't handle feedings which is entirely possible if the baby's apgars were so low). Unfortunately it just happens and it can happen VERY quickly. I've seen a baby go from asymptomatic to dead within 24 hours.

[fergus51]

http://www.pedisurg.com/PtEduc/NEC.htm
What is Necrotizing Enterocolitis (NEC)?

Necrotizing enterocolitis (NEC) affects mainly premature babies. It is the most common surgical emergency in newborns. NEC accounts for 15% of deaths in premature babies weighing less than 1500 grams. Overall death from those babies with NEC is 25%.

What causes NEC?

No single factor has been established as the cause of NEC. It is now thought that NEC is the result of a combination of several factors. The two consistent findings are prematurity and feedings. The premature intestine reacts abnormally and develops an acute inflammatory response to feedings leading to intestinal necrosis (death). Some postnatal issues including heart abnormalities, obstruction of circulation in the bowel, infection or gastroschisis are also associated with NEC.

In the premature infant, NEC usually occurs a week to ten days after the initiation of feedings. In the term baby, NEC occurs within one to four days of life if feeding is started on day one. The risk of NEC is less with later gestational age. Very few unfed infants develop NEC. One theory which connects feeding to bowel mucosa damage involves the overgrowth of bacteria when provided with a carbohydrate source. The digestion of the lactose in formula by premature infant is incomplete and the residual ferments (has a chemical change) that encourages growth of bacteria that cause inflammation.

[Jolie]

Originally Posted by lccougar02

Hey everyone,
I just took care of a 29 weeker yesterday. Her apgars were 2-4-6 at birth. She was doing well for my 8 hour shift and I came onto the unit today and they said she has suspected NEC. They said her stomach perferated from the OG tube. Can that really happen? i took care of her for 8 hours and saw no signs of NEC...why so sudden? Was it something I did?
~Jackie

Rest assured that it was nothing that you did. NEC remains largely a mystery, and a dreaded disease in the NICU.

NEC can present very suddenly in preemies, especially those who were compromised at birth. And since the signs and symptoms of illness in preemies are very non-specific, it can be difficult to detect in its earliest stages. Any instability in a preemie must be investigated thoroughly for this reason, such as temperature instability, increase in episodes of apnea and bradycardia, irritability or lethargy, change in feeding tolerance (such as increased residuals or spitting up), blood sugar instability, changes in color or O2 sats, increase in abdominal girth, change in appearance of the abdomen (such as mottled color, distended veins, rope-like appearance), change in stooling pattern including blood and/or mucous in the stool.

But your post is a little confusing to me. Babies with NEC typically have an og tube in place for decompression of the gi tract. While it is possible to perforate the stomach while placing one, it is highly unusual. I believe that the baby probably had an intestional perforation secondary to the NEC itself, and not stomach perforation due to the og tube.

If the baby has a perforation, she may be a candidate for surgery. If no perforation has occured, then medical management will probably be tried, including making the baby npo for an extended period of time, providing TPN and lipids thru a central line, antibiotics, frequent labwork to assess infection, platelet count, H/H, and frequent abd x-rays to monitor for perforation.

These babies are very ill, and require lots of careful attention. Their parents are often in a daze, as they may leave at night with their baby looking fine, and get a phone call the next morning that their child is gravely ill.

Best wishes to your little patient.

[mawjood]

hay, you did not tell us about feeding for your baby ,we have before one baby with suspecteded NEC , 26 weeks started feeding he was tolerated well 1cc q12h EBM only but when increasing to 1cc q8h it came NEC.
and other things if the baby have UAC or UVC, this increasing incident of NEC ,I did not thing it because something you did or from OG....
Good luck.....................

[lccougar02]

yeah we started feeding her about 12 hours before they realized her stomach perferated

[LilPeanut]

Her stomach or her intestine? Because stomach is a whole 'nother story than intestine.

[lccougar02]

her stomach

[LilPeanut]

Yeah, that's not NEC then.....right *looks to others to make sure*

I can't imagine though how a baby would get a perf'd stomach from an og.

[Gompers]

Originally Posted by LilPeanut

I can't imagine though how a baby would get a perf'd stomach from an og.

It happens. Same way an NG/OG or suction catheter can perforate the esophagus. These preemies have such fragile tissues, the pressure from pushing these tubes into their bodies is enough to perforate the GI tract.

I have seen a r/o NEC where the stomach was perforated with a feeding tube - he presented like NEC because he had tons of free air in his abdomen because every time he swallowed some air it leaked out from his stomach. His belly was big enough to put pressure on his lungs and compromise his breathing, so by the time we picked him up from an outlying hospital he was intubated - plus when they bagged him (thinking he was decompensating from NEC and sepsis) before intubation they pushed even MORE air into his stomach. He went right into surgery for us and the doc just put a patch on his stomach. He was on antibiotics for a week but since he hadn't fed yet and he was repaired so early, he didn't get peritonitis.

So some might say what happened to the baby that the OP was talking about was NEC, when it really was just free air in the abdomen and probably peritonitis because she had been feeding while the perforation was present. Peritonitis can be very serious and mimic NEC very easily - in this case, the baby was probably acting very septic with a very discolored, tender belly, and free air on x-ray. But after she had surgery and they found out what the free air was from, they probably shouldn't call it NEC anymore unless there is a change in the integrity of the intestines. Now, maybe peritonitis itself can cause NEC, I don't know, maybe that happened to her to?