Nec

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Specializes in NICU level III.

I was curious when other hospitals take their infants to surgery for NEC or suspected NEC? Our hospital waits until there is a definate sign that the bowel has perfed, in which some cases its too late for the infant. A nurse thats been here for awhile said they used to take them to surgery when there was portal air but now they don't for some reason.

Just curious what your unit does.

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Specializes in NICU.

For the most part, our surgeon will open them up only when they have perfed. There have been times however, when the baby is extremely acidotic, and it is more than likely that the entire gut is necrotic end to end. Our surgeon will then open them up just to "see exactly what is going on in there".

We also recently had a case where there was portal air, but no perf. Our surgeon didn't open them up until he had perfed. By that time however, he had

I'm glad you brought up this question BabiesRmylife - a lot of us have been wondering if this baby would have had a better chance if he had been opened up when we found the portal air, instead of waiting 12 hours or so later when he ended up perfing...

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Specializes in Neonatal ICU (Cardiothoracic).

The surgeons usually wait until they see a perf until they do an ex-lap. While we're waiting, the baby usually gets a vanc/gent/flagyl cocktail.

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Specializes in Level III NICU.

Our surgeons wait until a perf as well. Until then, it's NPO with antibiotics, serial x-rays and hope.

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Specializes in NICU level III.

We had an incident here recently where brown "fluid" was coming out an OG. Made the kid NPO, antibiotics, "regular" KUB's but no perf just portal air. This infant sat like this for 4 days finally perfing. Once perfed went to surgery he only hs 10% of his bowel, so VERY similar to Sweeper's response. Then after surgery his abd. incision ended up dehising & back to surgery the baby went. And now in even more crappy shape than before. Looks like the little tire boy from so much 3rd spacing! :(

I just wonder what the surgeons rational is for waiting until perf because by that point it seems that either ALL the gut is dead & you just take them off the vent to die, or they loose so much of their bowel that they end up basicaly with short gut.

Where do they think the portal air comes from? I mean if I would see portal air wouldn't you think something SOMEWHERE is leaking? I wouldn't assume that air just magically shows up like that for no reason.

I'm just SO frustrated with surgeons waiting until they perf & as previously mentioned it seems like its either too late or they end up with short gut. Surely this is a better way to go about this than to wait until a perf shows up on a KUB?!?!

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Specializes in Neonatal ICU (Cardiothoracic).

I don't know what they would do pre-perf though... the bowel is still "intact," so there's nothing to operate on.. just bowel rest, abx and gut decompression.

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Their rationale is that if they open them up, they can't do anything...

The only other time we do surgery is if their gut is so big, we can't ventilate them. You know something is very wrong if that is the case.

Based on all the NEC cases I have seen so far, if they die, they were always going to. Nothing you do is going to change that. You could have opened them up pre-perf, left their bowel in a silo, and it still would die... I watched that happen. This baby got sick so fast, they just went in to see what was going on. She only had portal air, but was hard to ventilate. Most of her bowel was pink, but a dusky pink. They placed her in a silo and waited. Over 2 days it turned gray, then black. We took her off then. We could have waited until she perfed (ie. she never did)...in that case she would have died too.

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Specializes in Nurse Scientist-Research.

My understanding, and it might not be correct, is that surgery is not a cure for NEC, it's damage control. All it does is take out necrosed bowel. There are no curative powers from cutting. To my understanding, antibiotics and bowel rest are the only things that "cure" NEC.

Our unit seems to have a rather high rate of NEC however maybe half of them never perf, and if they don't perf they generally do better than if they had surgery and had their bowels chopped and re-pieced. Some of those that never had surgery do get strictures later (obviously some scar tissue from some smaller portion of previously dead or dying bowel) but it's a very small percentage. Then they don't need another surgery to reconnect the bowel or the short gut issues.

Though I'm sure if you ask a surgeon they would say it's better to do surgery, but's that's because surgeons, by nature, cut.

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