I HATE NEC part 2...

[Sweeper933]

Seriously.

My primary - born at 24 2/7 and turned 32 weeks today. Had spontaneously perfed when he was a week or so old. Thankfully that was a "minor" perf and all he needed was a drain - never needed an ostomy or anything like that.

He finally got up to full / fortified feeds about 2 weeks ago, and (finally) extubated about a week and a half ago.

Started having some major reflux issues the past week - we were doing lots of things to help that issue.

Last night for me, he has his usual emesis after his feeds, along with his usual desats during them as well. By 0200 he hadn't stooled in 24 hours (which was a pattern he had developed). I gave him stim - got immediate return - small yellow seedy stool - his normal. I thought this would fix his emesis problem like it did the night before. His 0200 feeding goes in fine, just a small amount of emesis during that one. His belly was slightly full, but nothing different than before for the most part. His girth was within his normal range.

0500 feeding. He pukes about half of it up about 2/3 through the feeding (it was on a pump for 45 min), and then puked up the rest of it about 5 min after the feedin had gone in. By this time I'm starting to think it that either he has some serious reflux going on - or something else is going on. I let the docs know about his large amount of emesis and they start scratching their heads about it - still mostly thinking that it's just reflux since the rest of his abdominal assessment was still ok (as was his respiratory status).

But at 0630 he had a slightly mucousy / blood stool. I show it to the docs, and they took immediate concern. Babygram showed horrible pneumotosis / thickened bowel wall / dialated loops. I think the attending and I both said a few choice swear words as soon as the x-ray came up.

Thankfully (hopefully) we caught things in time. He was still on a HFNC 4L at about 34% - which was where he was the past few days. Did all the usual things (cultures, abx, anderson to suction....)

Seriously.... NEC is the bane of my existance.

I'm off to hopefully get at least 5 or 6 hours of sleep before I'm back tonight.

[TiffyRN, BSN, PhD]

We just had one of those cases that must be told to every new nurse in NICU. Infant with nothing to report at 7pm shift change, stable 1200 gr basically just a feeder/grower. Skip to the end of the story: support withdrawn before 8:30am. Massive NEC w/sepsis. Haven't seen it hit that hard and fast in a long time.

I hate NEC.

[Sweeper933]

Thankfully my little guy is still doing ok. He never had to be re-intubated (sofar). His gases have looked great. His x-rays still look really crappy, but at least he's not getting horribly acidodic.

Nothing worse than seeing the attending who's feathers NEVER get ruffled start swearing at an x-ray...