My first case of NEC

[boardchic]

Came in after 5 days off and found out one of my babes developed NEC and was sent to our nearest tertiary center the day after I had her. I want to throw up. I need to stop with the what ifs, but it's hard to not go there. Three years in our level 2 and this is my first. I hope she comes through ok.

[ilovenicu16]

Sorry Those cases stick with you forever. I remember we had one kiddo who had been there for a very long time,was supposed to be home already but the staff wanted to keep them for a week for increasing PO feeds. RA, no lines, no issues. She had some emesis throughout the day and her girth was always yo-yoing for months. Nothing new. I kept telling the MD and NNP with each emesis and charted everything to the detail. I left that shift and she randomly developed NEC, perfed, and had an embolism in her portal venous system. It was something so very rare there was nothing that could have prevented it, no signs it was coming, and nothing we could have done to save that baby. I beat myself up forever about it and the Docs/NPs thankfully said we did everything right and not to worry. I will never forget that day.

[HyperSaurus, RN, BSN]

Just experienced my first NEC last night. Really awful feeling. The worst part is that it may have been coming for a while--I don't know, I'm very new at this. 27 weeker with hx of vent, survanta, the works, was trialling NC because the doctor was wondering if he was developing CPAP belly (x-ray with gasseous distention of loops), belly rounded with loops. He's been tolerating feeds with aspirates 2mL and under, color looked good, abdomen soft and non-tender, but he's been refluxing with feeds and having accompanying apnea requiring mild to moderate stimulation. Anyways, I had him the night before. He had 4 apnic spells during his 1st 2 hour long feeding and 1 during the second, but according to the other nurses on the floor, he was better than 2 nights previous. Abdominal girth unchanged, no emesis, temps stable, aspirates 1.6mL and 2mL. I left at 0730. It sounds like he was going downhill by noon, intubated at 1630, abdominal circumference increased by 5cm at 2000, with abdominal xray showing "soap bubble pattern" across abdomen, not seen on the 1600 x-ray. We had him flown out to the Level IV center by 0200 (we don't have surgeons available).

It's definitely been on my mind--my husband says I didn't stop talking in my sleep all day. I just don't know if we've been ignoring that something was going wrong, if I should have notified for the apnea overnight (or would that have made a difference, considering that had been his MO for over a week). Hopefully the center we transferred him to last night will give us an update soon.

[NicuGal, MSN, RN]

NEC just sucks. We just had one a few days ago they had to open up in the unit. It is so insidious. .

[Elvish, BSN, DNP, RN, NP]

I sent a kid from newborn to NICU not too long ago. Term kid, 3.7kg and about 6 hours old when he started acting up for me. If his mother weren't diabetic we would likely not have caught it before it was too late, as he crumped so early. Born at about 0200 and night shift had been struggling with yo-yoing sugars as we sometimes do with IDMs. I go to check a sugar at 0745ish and find previous heelstick sites bruised and oozing significantly. NP ordered a CBC, which looked ok except for platelets of 29. Repeat platelets 27. Off to NICU he goes. A couple hours later, they call us back and tell us he's got NEC which is eating his platelets into oblivion, and (obviously) likely why his sugars had been so unstable. But his VS had otherwise been great, he'd voided and stooled a couple times already, was eating appropriately - a couple 10-20ml feeds in about 6 hours - and his tone was excellent.

It is very very scary how quickly NEC kids can go from undiagnosed to critical in a couple hours. Hate it.

[HyperSaurus, RN, BSN]

Wow, scary

[TiffyRN, BSN, PhD]

Thankfully since our unit moved to almost exclusive use of human milk we have seen the incidence and severity of NEC plummet. What just destroys us though is that we still see occasional overwhelming NEC totalis. Late NEC amongst former micros now close to term is often incredibly severe and much more lethal. It is theorized that many of these kinds of cases are related to vascular issues. Such as a inadequate vascular support of the gut as the preemie matures, or a thrombotic event.

This was interesting to me though provides little comfort to the nurses or certainly the affected infants & families.

Neonatology as a field has made such incredible advances in the last couple of decades and in my 11 years I have seen incredible positive improvements. NEC though remains an incredible challenge. Though I tend to remain largely scientific in my beliefs of supernatural entities; I come close to ascribing an evilness to NEC. Which in a way makes sense in that we (as humans) have often explained poorly understood/mysterious events as having a supernatural origin.

[TiffyRN, BSN, PhD]

The evil demon NEC came and snatched another one from us. I walked by the empty bedspace a few hours ago and it almost ripped my heart out.

As always; nicest family in the world.

Well to withdrawing support in

What I really want to say would violate our TOS, so I'll keep it safe and simple. . .

I hate NEC.

[Elvish, BSN, DNP, RN, NP]

(((hugs))) Tiffy.

[Jory, MSN, APRN, CNM]

I remember my first one and after a few you'll realize how common it is.

The first one I had was when I was about a week out of orientation, 23-weeker, and 24 hours after they started 1 ml breast milk Q4. I thought I did something wrong (baby perforated and died), but I was told that I would see quite a few perf after they start feeds on the micros.

..and they were right.

[babybums]

Took care of a baby that was supposed to be discharged the next day. That night, the baby developed NEC. It can happen that quickly. Very scary

[TiffyRN, BSN, PhD]

Since we went to all human milk for micros we just don't see so much NEC. What we are able to notice now is the association with transfusions.