Staging | Systemic symptoms | Gastrointestinal symptoms | Radiological signs | Treatment |
---|---|---|---|---|
IA Suspected NEC | Temperature instability, apnoea, bradycardia, lethargy | Gastric retention, mild abdominal distension, fecal occult blood positive | Normal or intestinal dilation, mild ileus | Absolute fasting, gastric decompression, antibiotic therapy for 3 days, waiting for pathogen culture results |
IB Suspected NEC | Same as IA | Bright-red blood from rectum | Same as IA | Same as IA |
IIA proven NEC (mildly ill) | Same as IA | Same as IA or IB, plus absent bowel sounds, and (or) abdominal tenderness, | Intestinal dilation, ileus, pneumatosis intestinalis | Same as IA, absolute fasting. If 24–48 h culture shows no abnormality, use antibiotics for 7– 10 days |
IIB proven NEC (moderately ill) | Same as IIA, plus mild metabolic acidosis and mild thrombocytopenia | Same as IIA,plus absent bowel sounds, definite abdominal tenderness, and (or) abdominal cellulitis or right lower quadrant mass | Same as IIA, plus portal vein gas, and (or) ascites | Same as IIA, absolute fasting. Supplement blood volume, treat acidosis, and use antibiotics for 14 days |
IIIA Advanced NEC (severely ill, bower intact) | Same as IIB, plus hypotension, bradycardia, severe apnea, mixed acidosis, DIC, neutropenia, anuria | Same as IIB, plus signs of generalized peritonitis, abdominal distension or marked tenderness, and redness and swelling of abdominal wall | Same as IIB, ascites | Transfer to the Surgical Department of Children’s Hospital for observation |
IIIB Advanced NEC (severely ill, bowel perforated) | Same as IIIA, plus suddenly aggravation of conditions | Same as IIIA, plus sudden aggravation of abdominal distension | Same as IIB, pneumoperitoneum | Transfer to the Surgical Department of Children’s Hospital for surgery |