My first NEC case was recently as well . . . ex 26 weeker who was 40 days old, on full feeds and had never had any problems tolerating the feeds. I'd had her many times before. First hands on she was fine. Second hands on she had had some emesis, fairly large residual (about half her feed), and increased girth and questionably firm abdomen. I called the Dr, she was made NPO and we drew labs & got a KUB, which the Dr. thought looked OK. Her CRP came back 14 so we started triple antibiotics. Her H&H were low, her platelets were 26. Next hands on her girth was increased and abdomen definitely firm, I got about a 9 cc residual of brown yuckiness, and there was stool with blood. Drew more labs, and her K+ was high, her Sodium was low. Her output was about nothing. She was a sick little baby . . . She got platelets & then rbcs, follow up KUB and shipped out to a higher level NICU because we don't do surgery. It was amazing to me how she went from "fine" to critical over a 12 hr shift. I did, however, felt like I did everything right . . . let the Dr. know as soon as she was questionable. Word is she's doing OK. NEC is scary!