I hate NEC

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Specializes in NICU.

So one of the babies that I was in the room with last night had been totally fine. Former 33 2/7 weeker, 5 days old, room air since birth, almost up to full feeds (the twin was exactly the same). All of a sudden around 0200 last night he started having major A/B episodes, drained completely of color, and started puking up his feeding. Suctioned him out - got his entire feeding (and then some) back, and then started getting fresh blood. Ended up being intubated and on a rate of 35. Anderson was getting fresh blood from the stomach... Not good. Only had PIV access (and of course was a terrible stick). Thankfully our attending on that night was able to soak the cord in saline and was able to get UV/UA lines in. By morning he was mostly stablized out... blood gases weren't too acidotic.

When we all came back in tonight, he was on the same vent settings, was on 10mcg/kg/min of doPamine, and the serial x-rays were showing pneumotosis, but no perf. Well his x-rays at 2000 tonight showed that he perfed. So surgery at the bedside (parents came), and it just showed that he is necrotic end to end :crying2:

Our surgeon is closing everything up right now, and is going to talk to the parents, and then withdraw support.

Not even 24 hours from when he first showed any signs of being sick.

Seriously - NEC is by far the scariest thing I've ever seen here in the NICU.

(sorry this was long... needed to "vent"...)

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Specializes in NICU, Infection Control.

I am sooo sorry, Sweeper. I know all too well how devasting NEC often is. All I can do is offer prayers. Take care.

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Specializes in Neonatal ICU (Cardiothoracic).

NEC is the cancer of the NICU. Devastating, mysterious, and often heartbreaking.

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Specializes in NICU.

I hear ya, it's a terrible terrible thing :(

(((HUGS))) for you all.

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Specializes in NICU.

I'm so sorry. I hate NEC too.

Just curious, though: was the surgeon going to be the one to decide about withdrawing support, or had s/he already talked to the parents about what if? I ask because we have a peanut right now who got NEC, parents agreed to a DNR before surgery just in case, then when the surgeons came back and said she had no viable bowel they withdrew the DNR. Now she's sitting there on an oscillator and dopamine and epi drips with pus flowing from her wound, five days later. I... don't get it.

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Specializes in NICU.
I'm so sorry. I hate NEC too.

Just curious, though: was the surgeon going to be the one to decide about withdrawing support, or had s/he already talked to the parents about what if? I ask because we have a peanut right now who got NEC, parents agreed to a DNR before surgery just in case, then when the surgeons came back and said she had no viable bowel they withdrew the DNR. Now she's sitting there on an oscillator and dopamine and epi drips with pus flowing from her wound, five days later. I... don't get it.

I'm not sure of the exact details right now, but I do know that the surgeon sat down with the parents and the attending on call tonight and talked about all of the possiblities. Currently, our surgeon wants to wait a day or so, see if he improves clinically at all, and then go back in to see if anything has re-profused. Like I said, I'm not too sure on all of the details... but that's what's going on right now. I havn't been able to get down there to see how the baby is doing clinically yet...

Yuck.

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Specializes in NICU, PICU, educator.

I hate NEC too. What I really hate is when we have a kid that is DNR and then we have to lift the DNR for OR because the surgeons talk the parents into surgery. Seems that the DNR never gets reinstituted after that since, at least our do this, the surgeons will say, oh here , this will probably help, don't give up. Arggg. And we know it is futile. That is what breaks my heart!

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I'm sorry Sweeper.

I hate NEC too.

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Specializes in LTC, assisted living, med-surg, psych.

(((((Sweeper)))))

My friend's granddaughter died of NEC almost exactly a year ago. Poor baby had been perfectly healthy except, of course, for the fact that she was born three months early. She was taking Mom's milk, on room air, growing heavier by the day, the whole enchilada.......then one morning she looked a bit ill, and by noon she was gone. I'm no NICU nurse---I couldn't take it!---and NEC is a big reason why.:o

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Specializes in NICU.

Marla, please give my condolences to your friend.

NEC is practically an anthropomorphized evil in my mind. We had an ex-30 odd weeker getting ready to go home, and literally on the day of discharge his belly blew up, and he was too unstable to go to the OR, so the surgeons came up and opened his belly at the bedside and there was just nothing they could do. Everything was already necrotic. The poor peanut went from corificeat test to dead in less than 12 hours.

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Specializes in NICU/Neonatal transport.

If it's NEC totalis, on our unit, they aren't given a choice. The surgeons run the bowel, if it's all gone, they put it all back in, close the baby up and bring mom and dad in to say goodbye (we do all our NEC surgeries on the unit)

And even the ones it doesn't kill in the short term, the TPN often kills them a couple years later. *sigh

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Specializes in NICU.

Thanks everybody for all of you kind words! NEC is definately one of the most horrid things we see here in the NICU... going from completely fine (in the corificeat) to being taken off of support in

The poor baby I was refering to in my original post was taken off of support around 9 this morning. Parents just wanted to give themselves a few hours sleep to make sure they were making the right decision. Thankfully the twin is still behaving himself.

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