Necrotizing enterocolitis in the premature infant: neonatal nursing assessment, disease pathogenesis, and clinical presentation

Abstract

Necrotizing enterocolitis (NEC) remains one of the most catastrophic comorbidities associated with prematurity. In spite of extensive research, the disease remains unsolved. The aims of this article are to present the current state of the science on the pathogenesis of NEC, summarize the clinical presentation and severity staging of the disease, and highlight the nursing assessments required for early identification of NEC and ongoing care for infants diagnosed with this gastrointestinal disease. The distributions of systemic and intestinal clinical signs that are most sensitive to nursing assessment and associated with Bell Staging Criteria are presented. These descriptive data are representative of 117 cases of NEC diagnosed in low-gestational-age infants (<29 weeks' gestation). The data highlight the clinical signs most commonly observed in infants with NEC and thus provide NICU nurses an evidence-based guide for assessment and care of infants with NEC.

Figure 1

X-ray of neonate with pneumatosis intestinalis, observed in Bell Stage II Necrotizing Enterocolitis. From Kim W-Y, Kim WS, Kim I-O, et al: Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol 2005;35:1056-1061.

Figure 2

Photograph of neonate with abdominal distention, commonly associated with necrotizing enterocolitis Noerr, B. (2003). Beyond the basics: Advanced physiology and care concept: Cultivating clinical expertise. Adv Neonatal Care, 2003; 3,3 107-120