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 Neonatal ICU (Cardiothoracic).
I have read studies that state that formula fed babies are 79% more likely to develop NEC than EBM fed babies. With those kind of statistics, why can't we mandate that EBM be used for our at risk population??? I know, you can't force a woman to pump but using donor milk and persuading more mommies seems like a no brainer.

Can you post a link to that study?

I have NEVER seen any literature that showed a 79% increase in risk with formula use. There are too many variables in NEC to even guess at a number like that.

Donor milk is EXTREMELY hard to obtain, and is illegal in NYC for instance. I believe the nearest bank is in Denver.

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Specializes in Community, OB, Nursery.

Nearest milk bank to you is Raleigh, I think. Either way, a long haul. We are spoiled, cause we are close by there & we pretty much take donor milk for granted.

I have heard studies that say breastmilk has protective effects against NEC, but I didn't know any percentages. My understanding is that the jury is still out on what exactly causes NEC, though there are a million theories. I have seen only a few cases of NEC, but I loathe it. Bleh.

Some interesting articles I found:

http://74.125.47.132/search?q=cache:2xmZCQxnPdkJ:txpeds.org/u/documents/christine_e._bishop,_m.d._necrotizing_enterocolitis_in_the_era_of_increasing_donor_breast_milk_use_in_premature_infants.ppt+%22NEC%22+%2B+breast+milk&hl=en&ct=clnk&cd=10&gl=us

http://bpsu.inopsu.com/publications/reports/nnec.html

http://www.guideline.gov/summary/summary.aspx?doc_id=10578

Wait....did you say DBM is illegal in NYC?! :eek:

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Specializes in NICU.

"Infants who received donor human milk were three times less likely to develop NEC (RR 0.34; 95% confidence interval (CI) 0.12 to 0.99), and four times less likely to have confirmed NEC (RR 0.25; 95% CI 0.06 to 0.98) than infants who received formula milk."

http://fn.bmj.com/cgi/content/abstract/88/1/F11

I'm still looking for the 79% stat I read, I may have to ask the lactation consultant at work.

Why on earth is donor milk illegal in NYC??? At the facility where I'm from in the Bay Area we had a milk bank on site and the docs would just write an order for it as if it were a med. There was unfortunately a short supply so only the littlest peanuts without their own Mommy's milk would get it. Parents just sign a consent form like they would for blood products. Sadly, the facility I'm at now is pretty backwards on the BF thing, I'm trying to help change that. The benefits of donor milk so far out weigh the risks! I'd much rather give donor milk than say, amphoterrible!!!

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Specializes in Neonatal ICU (Cardiothoracic).

Hmm.. Ill need to see if I can access that article at school. It doesn't say anything about preemies or preexisting illness, etc....

I honestly have no idea why donor milk is illegal here. One of my grad school professors told us this a few weeks ago.

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Specializes in PICU.

http://massbfc.org/faq/faqMilkbank.html

This link states the regulations CA an NY have for milk banks but doesn't say that they're illegal.

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Specializes in Nurse Scientist-Research.

I guess we are very lucky that one of our neo's started a milk bank in our area, but we had been getting donor EBM from another bank that was about 200 miles away before. Our unit is very aggressive in administering only EBM be it mom's or donor to preemies especially under 30 weeks. We don't seem to have had as much NEC in the last year but we still have quite a bit.

Our neo's take on things is that donor milk does not really need consent. We have an information sheet that mom signs but it is not needed to actually administer donor EBM to the baby. They have stated that unless the parents specifically object then we are to give it if ordered. Now, in reality that has never happened. Since that new philosophy went in place about a year ago we have given much more donor EBM, but no baby has (to my knowledge) received any without the information sheet being signed.

I don't have any research in front of me, but what I remember being educated when I went through my internship classes was that the research was mixed about whether early feeding versus later feeding helped or made NEC more prevalent, but that generally consensus had it that EBM was better than formula any day and under any circumstances. It made me cringe anytime I had to give those first few feeds with formula, it just seems wrong to do to that delicate gut. Thankfully with our new practices that rarely happens anymore.

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We just lost a twin this weekend to NEC. I heard Sat moring when I was walking out the door she had pneumatosis on her am xray. I am guessing that either it was a scheduled morning xray or she was fine all night until her last feeding and an xray was ordered. They transferred her that day to Children's (don't do surgery here), and everything was dead by the afternoon. She was only 800g... TTTS 28 weeks about 10 days old. Sucks, although I haven't seen any NEC deaths and only 2 other cases since being here for 6 months.

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