A 29-week neonate develops sudden deterioration with bradycardia, hypotension, and a tense, distended abdomen at day 10 of life. Abdominal X-ray shows pneumatosis intestinalis with portal venous gas. What is the MOST appropriate immediate management?
- A Immediate surgical exploration (laparotomy)
- B Emergency peritoneal lavage
- C NPO, orogastric tube decompression, broad-spectrum antibiotics, and NICU supportive care ✓
- D Bowel rest, probiotics, and observe for 24 hours
Correct answer: C. NPO, orogastric tube decompression, broad-spectrum antibiotics, and NICU supportive care
Explanation
The clinical picture is consistent with necrotizing enterocolitis (NEC) Bell stage IIB. Initial management of NEC (in the absence of intestinal perforation on X-ray) is medical: NPO for 10–14 days, orogastric tube for bowel decompression, broad-spectrum antibiotics covering gram-negative organisms and anaerobes, and hemodynamic support. Surgery (peritoneal drain or laparotomy) is indicated only if there is evidence of perforation (pneumoperitoneum), clinical deterioration despite medical management, or fixed abdominal mass.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.