Necrotizing enterocolitis (NEC) modified Bell staging is used to guide management. Stage IIB NEC is defined by which specific criteria?

• A Suspected NEC with mild systemic signs and normal radiograph
• B Definite NEC with moderate illness, metabolic acidosis, thrombocytopenia, and pneumoperitoneum
• C Advanced NEC with severe hemodynamic instability and clinical deterioration requiring surgery
• D Definite NEC with mild systemic illness, pneumatosis intestinalis, and portal venous gas ✓

Explanation

Modified Bell staging: Stage I (suspected) has non-specific signs; Stage IIA (definite, mild) has pneumatosis intestinalis only; Stage IIB (definite, moderate) has pneumatosis with portal venous gas, metabolic acidosis (pH 7.25–7.35), mild thrombocytopenia, and abdominal wall edema on X-ray. Stage IIIA (advanced, no perforation) has severe systemic illness, acidosis, and ascites without free air; Stage IIIB has pneumoperitoneum (perforation) and requires surgery. Stage IIB is managed medically but with close monitoring for deterioration.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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