A male infant born at 25 2/7 weeks' gestation (birth weight 800 g) develops tachycardia and abdominal distension prior to passing a blood-tinged stool. His physical examination reveals decreased tone and activity, tenderness on palpation of the abdomen, and a paucity of bowel sounds. His abdominal x-ray shows diffuse pneumatosis without pneumoperitoneum or portal venous air. His parents arrive during initial stabilization of their infant and ask to speak to the attending neonatologist.

Which of the following statement regarding this infant's condition is correct?

A. Because of his abdominal findings, the infant likely has hypersensitivity to mother's breast milk, and she should stop pumping.

B. Unless intestinal perforation occurs, their infant's risk for growth failure is not significantly increased as a result of this condition.

C. Their infant is unlikely to develop an intestinal stricture if there is no bowel perforation.

D. This condition puts their infant at increased risk for neurodevelopmental impairment.

E. The incidence of this condition is inversely related to gestational age and birth weight, but these characteristics do not increase the risk of mortality.

The correct answer is D.

Explanation: Necrotizing enterocolitis (NEC) occurs most commonly in premature infants. The incidence of NEC is inversely related to 2 important risk factors: birth weight and gestational age. In addition, the risk of mortality from NEC is higher for the smallest infants born at lower gestational ages. Mortality is also related to the need for surgical intervention, and the extent of bowel involvement, with survival directly related to the length of remaining bowel after surgical resection. Even in the absence of surgical intervention, NEC increases the incidence of other prematurity-related complications, including chronic lung disease, growth failure, neurodevelopmental delays, and hospital-acquired infections. Additionally, infants with NEC who require surgery have a greater risk of neurodevelopmental impairment (2-3 times greater risk than infants managed with medical therapy alone). There is no evidence to suggest that hypersensitivity to breast milk is involved in NEC pathophysiology. Strictures may occur weeks to months after an episode of NEC, even in the absence of bowel perforation.

Go to AccessPediatrics for more information on necrotizing enterocolitis    

Source: Rudolph's Pediatrics, 22nd Edition, Self-Assessment and Board Review Copyright © 2014 by McGraw-Hill Education. 

Photo credit: Neonatology Clinical Practice and Procedures