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NEC – medical management — RACP Paediatrics MCQ

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ModerateNeonatalNEC – medical managementRACP Paediatrics

A 29-week premature infant on day 10 of life develops abdominal distension, bile-stained aspirates, and bloody stools. Abdominal X-ray shows pneumatosis intestinalis (intramural gas). The infant is haemodynamically stable. What is the most appropriate initial management?

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Correct answer: A — Nil by mouth + IV antibiotics + NG decompression

Pneumatosis intestinalis on abdominal X-ray with clinical features of feeding intolerance, abdominal distension, and bloody stools confirms necrotising enterocolitis (NEC). Initial management is medical: nil by mouth, nasogastric decompression, IV broad-spectrum antibiotics (e.g., amoxicillin + gentamicin + metronidazole), and TPN. Serial abdominal X-rays should be performed.

Reference: RCH Melbourne – 2023 – Necrotising Enterocolitis CPG; RACP Paediatric Curriculum – Neonatology