I hate NEC

Specialties NICU

Published

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"...)

Specializes in NICU.

So sorry. We lost a twin like that a few months ago, a month old, ex 27weeker. Doing well, then went bad. The sibling did great, and went home a few weeks later.

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Specializes in NICU level III.

NEC is horrible. We had one of the same things happen in our unit a few days ago. Baby started looking sick, threw up, was on the vent. Called the Dr. did KUB, looked bad (pneumotosis), started meds around 0200 & when I came in the next day baby had died around 1700. They opened the baby up at beside during the day & entire bowel was dead. It's so horrible!!!!

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NEC is definately the scariest thing in the NICU. We thankfully don't see it too often, but when we do it's bad. We even had a 35 weeker twin die in less then 12 hours. She was supposed to go home the next day. It's amazing how subtle it comes on and how devistating it can be.

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Specializes in NICU.

Have to add on that I hate it as well. My patient the last 3 nights suddenly passed away from it in a matter of 8 hours last night.

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Specializes in NICU, adult med-tele.

NEC is practically an anthropomorphized evil in my mind.

Mine too!

The first kid I ever had pass away on me was a 34 weeker with NEC. She was in the stepdown one minute, within a couple hours, HFOV, dop/dobuta, you name it. Also the first time I have "pushed" blood.

It was really sad. The mom was 15. How do you go back to your friends in high school and tell them your baby died?

Hate it! Hate it hate it hate it. That and meconium aspiration. Hate that too.

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Someone posted once in one of the threads that NEC was evil incarnate, and I can think of no better way of describing it. I dont remember who or which thread though.

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Specializes in NICU.
Someone posted once in one of the threads that NEC was evil incarnate, and I can think of no better way of describing it. I dont remember who or which thread though.

Me, and I still believe it. ITA with Aja re meconium aspiration as well. It's the things you don't know about in advance that are the scariest. Cardiacs, CDH, etc, those are bad, sure, but NEC, mec, surfactant deficiency... you better hope you're in a level III+.

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Specializes in NICU.
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

I'm new to the NICU (and new to nursing--just graduated in May 2008). I was just wondering about TPN killing the babies a couple years later... why is this?

Thanks!

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Specializes in NICU.
I'm new to the NICU (and new to nursing--just graduated in May 2008). I was just wondering about TPN killing the babies a couple years later... why is this?

Thanks!

It fries their liver. Not sure of the pathophysiology of it, but if you google "short gut" and "TPN" you'll find a lot of parent blogs and such. Sometimes even kids in the NICU for more than a few months will end up with TPN cholestasis - end up on Actigall, cycling the TPN, etc.

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TPN kills the liver. I had one today who had 30cm of bowel removed due to nec and has liver issues. Hes on actigall, labs this am were : Alkphos 1252 (norm 44-147) , SGOT 222 (norm 20-55); SGPT 336 (norm 0-54).

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Specializes in NICU.

I am so sorry. I hate NEC, too. More than any other illness I have encountered.

I have seen one of my babies, a 36 weeker, go from being completely asymptomatic, on full feeds in an Isolette, to dying from NEC within 12 hours. Because it was so rapidly invasive, the Neos referred to it as "fulminating NEC". :(

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Specializes in NICU.

I know this is a NICU forum, but does anyone know if TPN affects the liver of adults the same way it does with infants? Just wondering if that's strictly a NICU problem or if it occurs in other areas of nursing.

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