What can you tell me about NEC?

Specialties NICU

Published

I floated to NICU and my pt got NEC and likely won't survive. I have to float to NICU frequently (usually once a month) but we typically get feeder/growers assigned to us.

I feel like I caught the symptoms early, but OMG, it was lightning fast and really sort of shocked me! I don't shock easy and have had pts go south quickly in PICU, but this was like: healthy/stable baby, to dying in just a couple of hours!

I don't think I 'missed' anything, but I can't stop worrying maybe if I'd caught it just a bit sooner, her outcome would be different.

The only symptoms started in the afternoon: a little tachy (she'd been 160-170's all day, and jumped to 180's) and her belly was starting to become distended. She was stooling, active bs, not tachypnic, she was on 21% @ 1L and sat'ing 100% all day. Normothermic all day. She'd just had 2-2.5ml residual before feeds and then when she got symptomatic it was 6mls.

By the time I left she was on an oscillator, had a picc and working on an artline, and putting in drains at the bedside. I gave prbc's and ffp, and had orders for cryo, and more prbc's. Her gases were crap. They were about to start pressors.

What kinds of things do you see before they get NEC? What might I have missed? I've taken care of all kinds of awful stuff (kids beaten into a coma, drowning, heart surgery kids, traumas...) but this has me rattled :(

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Specializes in NICU, PICU, PACU.

That is NEC....it is a sneaky, insidious thing. Your kid can be perfectly fine one minute and that bad within 10 minutes. Usually belly distention, low temp, sudden aspirates or emesis, heart rate starts to increase as they get shocky.

It doesn't sound like you missed anything...NEC is one of those things that catches you off guard almost all the time :(

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Sounds about right. I remember I helped admit a baby once from an OSH. Baby was ex 26 wkr but now term, never had any gut issues, was supposed to go home in the next day or two, parents were just finishing up with teaching, getting prescriptions, etc.

Report we got was that baby PO fed at 3am and was fine, by 6 the baby was lethargic, wouldn't eat and belly was distended, by 7 the baby was coding. Admitted to my hospital (referring hospital did not have surgical abilities) at 9am, belly was opened at bedside by 10 - nec totalis. Intestines were placed in a silo in an attempt to keep the baby alive until the parents could get there because the docs knew that closing and pushing everything back in there would surely cause another arrest. Baby was dead by noon despite ongoing resusitative efforts. The parents never came in, we think they were probably in complete shock, after months of worry if their baby was going to make it, they finally felt "in the clear" and then just like that, he was gone.

There's a reason NICU nurses say you can "never trust a preemie", it's because it's true.

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Specializes in NICU, ICU, PICU, Academia.

You missed nothing - and there was nothing you could have done differently. Take solace in that.

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Thanks, everyone. It really makes me feel better to read your responses.

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Specializes in Nurse Scientist-Research.

Almost any NICU nurse with more than 2 years experience can tell a tragic tale of one of their personal patients that developed overwhelming NEC. All of us are waiting for the equivalent of surfactant for the gut, some great innovation that will chase this NICU demon back to where it belongs.

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Specializes in NICU.

NEC is terrible. You did what you could. It's an insidious disease.

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why not do trophic feeds and keep them on TPN until they're term, or closer to term?

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Specializes in NICU, PICU, PACU.

You will do in their liver if you keep them on TPN too long. It just isn't feasible to keep them in tropic feeds for up to 17 weeks.

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we wish they could but tpn is just not a nutritious substitute. Like NicuGal said you will destroy their liver - those kids who get bad nec and end up short gut usually end up with pretty bad livers too, also the nutrients they need to grow just isn't optimal from TPN, they end up with a lot of mineral deficiencies and brittle bones/ostepenia, also the infection risks associated with being on tpn.

Trust me, I hate feeding babies (and I don't even work NICU anymore, I work CICU but they get NEC too though usually for different reasons) but the benefits of using the gut do outweigh the other associated risks usually.

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Specializes in NICU.

umcRN is right: the benefits of enteral feeds outweigh the risks. But when the bad outcome hits YOUR patient, it's hard to remember that.

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The only other "sign" I can think of is a normally not-fussy baby becoming really fussy. Twice this has happened where the only symptom was an hour-long bout of crying/inconsolability before the real symptoms start.

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