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Question: Neonatal
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You are seeing a 5 day old infant born term without complications brought to the ED because the parent noted a streak of bright red blood in the diaper. The baby is formula feeding well, not lethargic, has no fever, and has had a few non-bilious spit-up episodes. Physical exam shows mild abdominal distension; no anal fissure seen.
Kelly November 3, 2020 - 11:00 am
D) Term babies with NEC are more likely to have an underlying associated condition
Term babies account for 10% of all NEC cases. Age at presentation is inversely correlated with gestational age; the average chronological age at presentation for premature infants < 30 weeks gestation is 20 days, but the average age for term infants is 5 days. Term infants have a better prognosis. Term infants usually have an underlying risk factor; common risk factors include congenital heart disease, post-natal hypoxia or respiratory distress, gastroschisis, chromosomal abnormalities, maternal diabetes, eclampsia, or chorioamnionitis. Formula feeding and PRBC transfusion. Infants may present with sepsis / poor perfusion, feed intolerance, abdominal distension, and grossly bloody stools, but they may also present more subtly with mild symptoms; a high index of suspicion is warranted. Pneumatosis intestinalis on plain radiograph is pathognomonic although not always appreciable early. Most patients (~70%), preterm and term, are managed medically with NPO/NGT, parenteral nutrition, broad spectrum antibiotics.