A 3-day-old neonate born at 32 weeks gestation has feeds withheld due to abdominal distension, bloody stools, and pneumatosis intestinalis on abdominal X-ray. Platelets are 40,000/µL and CRP is 45 mg/L. Which staging best fits this presentation and guides the management approach?

• A Bell's Stage I — suspected NEC; bowel rest and broad-spectrum antibiotics
• B Bell's Stage IIB — severe NEC with metabolic acidosis; immediate surgical referral
• C Bell's Stage IIIB — advanced NEC with perforation; emergency surgery
• D Bell's Stage IIA — definite NEC without perforation; bowel rest, IV antibiotics, and close monitoring ✓

Explanation

Bell's staging: Stage IIA is characterised by definite NEC with pneumatosis intestinalis on radiograph, thrombocytopenia, and elevated inflammatory markers without signs of perforation or severe metabolic acidosis. Management is medical — NPO, nasogastric decompression, IV antibiotics for 10–14 days, and close monitoring for deterioration. Stage IIIB would require surgical intervention and presents with free air on X-ray, profound acidosis, and cardiovascular collapse.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.