A 1.1 kg, 29-week preterm neonate on day 5 of life develops abdominal distension, bilious aspirates, bloody stools, and a fixed dilated bowel loop on X-ray. What is the MOST appropriate initial intervention?
- A Immediate surgical exploration
- B NPO, IV antibiotics, parenteral nutrition, and nasogastric decompression ✓
- C IV fluconazole and rectal washouts
- D Barium enema to identify obstruction level
Explanation
This presentation is classic for necrotizing enterocolitis (NEC) — bilious aspirates, abdominal distension, bloody stools in a preterm VLBW infant. The fixed dilated bowel loop indicates advanced NEC (Bell stage IIIA). Initial management is medical: NPO, nasogastric decompression, broad-spectrum IV antibiotics (covering gram-negatives and anaerobes), and parenteral nutrition. Surgical exploration (peritoneal drain or laparotomy) is reserved for perforation (pneumoperitoneum on X-ray) or clinical deterioration despite medical management. Barium enema is contraindicated. Fluconazole is not the primary treatment.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.