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NEC Staging — RACP Paediatrics MCQ

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HardNeonatologyNEC StagingRACP Paediatrics

A preterm infant at 28 weeks develops bloody stools, abdominal distension, and metabolic acidosis on day 14. X-ray shows pneumatosis intestinalis and portal venous gas. What is the Bell stage?

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Correct answer: C — Bell stage IIIA (advanced NEC, severely ill, no perforation)

Portal venous gas in addition to pneumatosis intestinalis indicates more advanced NEC (Bell stage IIIA if no perforation, IIIB if pneumoperitoneum). Stage IIIA presents with haemodynamic instability, metabolic acidosis, and DIC. Urgent surgical consultation is required. Peritoneal drainage or laparotomy may be needed.

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