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NEC Initial Management — RACP Paediatrics MCQ

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ModerateGastroenterologyNEC Initial ManagementRACP Paediatrics

A preterm infant at 30 weeks gestation develops abdominal distension, feed intolerance, and bilious aspirates on day 10 of life. Abdominal X-ray shows pneumatosis intestinalis. What is the initial management?

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Correct answer: E — NPO, IV antibiotics, and gastric decompression (modified Bell stage IIA/IIB NEC)

Pneumatosis intestinalis on X-ray confirms NEC (Bell stage II). Initial management includes bowel rest (NPO), IV broad-spectrum antibiotics (covering Gram-negative and anaerobic organisms), gastric decompression, and serial abdominal examinations/X-rays. Surgery is indicated for perforation, clinical deterioration, or failure of medical management.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: NEC