A 1200 g neonate born at 30 weeks gestation develops abdominal distension, bilious vomiting, and bloody stools at 10 days of life. X-ray shows pneumatosis intestinalis and portal venous gas. Bell staging of this condition would be Stage IIB. Which of the following is the MOST appropriate next step?
- A Immediate surgical exploration
- B Peritoneal drainage only
- C Bowel rest, nasogastric decompression, IV antibiotics for 14 days ✓
- D Bowel rest, IV antibiotics for 7 days, repeat X-ray in 6 hours
Explanation
Bell Stage IIB NEC (definite NEC with systemic illness, radiological pneumatosis, and portal venous gas but no perforation) is managed medically with complete bowel rest (NPO), nasogastric decompression, and broad-spectrum IV antibiotics for 14 days. Surgery is indicated for Stage III (perforation, clinical deterioration despite medical management, or abdominal wall erythema indicating peritonitis). A 7-day course is insufficient for advanced NEC. Peritoneal drainage is a palliative or temporizing measure in critically unstable very low birth weight infants who cannot tolerate laparotomy.
Reference: Ghai Essential Pediatrics, 10th ed.
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