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Necrotising enterocolitis — MRCPCH FOP MCQ

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HardNeonatologyNecrotising enterocolitisMRCPCH FOP

A 26-week premature girl on day 12 develops abdominal distension, bile-stained aspirates and bloody stool. She is lethargic, thrombocytopenic and abdominal radiograph shows pneumatosis intestinalis. What is the most likely diagnosis?

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Correct answer: E — Necrotising enterocolitis

A premature infant with systemic illness, abdominal distension, bloody stool, thrombocytopenia and pneumatosis has necrotising enterocolitis. Pyloric stenosis causes non-bilious vomiting without pneumatosis. Cow's milk allergy may cause blood in stool but would not usually cause systemic instability and pneumatosis. The pearl is that NEC is a medical and surgical emergency.

Reference: BAPM Framework for NEC; NICE neonatal care guidance