So I have seen my fair share of NEC cases...simple NPO and ABx for 7-14 days to dying in less then 12 hours. But, this patient that I have is just not fitting into one I have seen. I am asking for your opinions, comments, and answers....This baby is a 30 6/7 week twin who was surfed and on CPAP for 4 days then went to prongs. He was 6 days old when I first took him as a patient, and he hit full feeds (32ml Q3hr) at my first hands on (don't get me started on that!). I thought his belly felt a little firmer then it should, but everything else was normal, so I fed him. He got really fussy an hour later, so I took my gut feelings and talked to the NNP who gave me a glycerin order. I gave that and by my next hands on his girth went up 1cm, he had a 14ml residual and had a nice bloody stool. We made him NPO. By morning they electively intubated him and started ABx...they did all the right things and what we thought was the right time. They didn't hesitate at all. This was Friday. By Sunday at 4am he was perfect. Everything was back to normal, assessment wise, and they were planning to extubate.At 530, everything changed. He started riding the vent. After 30 minutes, I talked to the NNP and we did a gas...his pH 7.1 and CO2 80! By Tuesday morning at the end of my shift, he had been given blood, platelets, albumin..you name it...his girth went from normal and 24cm to a huge, tight and shiney 31cm!It's now Thursday night and he isn't getting better. He hasn't gotten worse, but he isn't getting better. He has gained a pound since that Friday, drops his platelets every other day, has band waves (they spike to the 30s then drop to 10), and now has pseudomonas pneumonia to top it off. He is on a PIP of 29 and he doesn't breathe over the vent even when he is awake and his girth is up to 31.5cm.Why won't he get better? He initially responded, and now is just...not. Do you think he has a chance?? Or do you think he will eventually perf and die? I can't imagine his bowel looks good underneath that skin!Let me know your thoughts....I hate NEC!