nec;are we doing something wrong???

[lisailovenicu]

Last night we had a baby in our unit die; she had nec. She supposedly was not showing any symptoms until 6pm and her abd. became distended and girth up by 2cms. They obtained films at this time and found pneumotosis but no free air. The baby was made NPO, antibiotics started, and a replogle in place to sx. At 9 pm the baby's belly was 2cms larger and the 2nd set of films obtained..still pneumotosis but no free air. The neo had spoke to the pediatric surgeon from the beginning but called back at this time and asked her to come in; she took the baby to surgery about 10pm and open and closed the baby. The bowel was necrotic from top to bottom; not enough for survival..My question is; have any of you seen nec happen so quickly and with such little symptoms and the bowel to necrose that quickly???We all just keep asking ourselves if we missed something or if we could have done things differently???This was a 30 week baby on full feedings; she was on the vent for one day. Recieved survanta x 1; came off to room air. had a UAC for 3 days and it was dc'd before feeds started. she started on feeds 1ml q 3 hrs and increased 1ml every 3hrs..what are your practices on feedings and advancement..we can't help but question this also???thanks

looking for any suggestions on current practices that may help us detect this sooner next time or prevent it from hapening again???

[Gompers, BSN, RN]

Sounds just about right to me. There is nothing to do but make the baby NPO, insert an NG to suction, get frequent X-rays, and start on antibiotics - we do Amp-Gent-Flagyl. Surgery won't place drains unless there is free air, at least not here. Usually we wait and take them to surgery after the acute phase is over with, but there are times that we'll take a kid to surgery STAT.

Unfortunately, it seems like the kind of NEC that hits quickly - especially when it's a "well" preemie or even a full-term kid - is the most devastating. Those micropreemies who are rule-out NEC for weeks at a times, it seems like they just end up with small areas of scar tissue and things like that. But like I said, when a kid that is doing well otherwise suddenly gets NEC - like the kind you described above, it's so painfully obvious - it's those cases where we've seen total destruction of the GI tract within a few hours' time.

There was nothing else you guys could have done, in my opinion.

[sparkyRN]

Sometimes that is just how NEC happens. Please remember the damage to the gut could be the result of an anoxic or hypoxic episode the baby underwent before, during or after birth. And really, the "experts" will tell you no one knows exactly what causes some babies to get NEC.

Speaking from experience, NEC does happen in full term babies, though thankfully it is rare. Usually their first presenting symptom is abdominal distention. Being a 30 weeker, there may have been subtle clues of illness before the baby showed abdominal distention. The classic precipitating event that I've noticed with preterm NEC babies is apnea. I start to get very nervous if I have a feeder/grower who starts to have apneic episodes where before their were none. Or, they have had a few, but the episodes become more frequent or require an increase in stimulation. Granted, this does not always mean NEC. But it could. Fortunately, our doctors and NNPs will take a change like this seriously enough to at least get serial CRPs to check for infection.

[dawngloves, BSN, RN]

Exactly. NEC happens and sometimes you can't do anything about it.I'm sorry this was so hard for you. (((HUGS)))