Anemia of Prematurity - Portal Neonatal

• Rectal biopsy
o This procedure is the criterion standard for diagnosing Hirschsprung disease.
o This biopsy is a pediatric surgical procedure that is performed either as a bedside
suction biopsy or as an open biopsy.
o Ganglion cells in the biopsied specimen definitively rule out the diagnosis. The
absence of cells, while suspicious for disease, merely may be the result found in the
particular specimen obtained and is not 100% conclusive.
• Placement of a peripheral arterial line may be helpful at the beginning of the patient's
evaluation to facilitate serial arterial blood sampling and invasive monitoring.
• If the baby is deteriorating rapidly, with apnea and/or signs of impending circulatory and
respiratory collapse, airway control and initiation of mechanical ventilation is indicated.
• Abdominal decompression
o Decompression is essential at the first sign of abdominal pathology.
o If possible, use a large-bore catheter with multiple side holes to prevent vacuum
attachment to the stomach mucosa.
o Set the catheter for low continuous suction and monitor output.
o If copious amounts of gastric/intestinal secretions are removed, consider IV
replacement with a physiologically similar solution, such as lactated Ringer solution.
• Paracentesis
o Ascites can develop during fulminant NEC and can compromise respiratory function.
Remove ascites using intermittent paracentesis.
o Ultrasonographic guidance can facilitate paracentesis.
o After completing the procedure, significant fluid shifts between the intravascular and
extravascular spaces are possible, so avoid removing large amounts of fluid at one
time.
• Place an intra-abdominal drain as an alternative to laparotomy if the baby is not a surgical
candidate.
Histologic Findings: Inspecting the affected bowel reveals mucosal ischemia, progressing to cell
death and sloughing. Necrosis can be limited to the mucosal layer, observed radiographically as
pneumatosis, or it can affect the full wall, resulting in perforation with subsequent peritonitis. Necrotic
and/or perforated intestine must be resected.
Medical Care:
TREATMENT Section 6 of 10
• Diagnosis of NEC is based on clinical suspicion supported by findings on radiologic as well as
laboratory studies. Treatment of NEC depends on the degree of bowel involvement and
severity of its presentation. Objective staging criteria developed by Bell have been widely
adopted or modified to help tailor therapy according to disease severity.
• Bell stage I - Suspected disease
o Stage IA
� Mild nonspecific systemic signs such as apnea, bradycardia, and temperature
instability are present.
� Mild intestinal signs such as increased gastric residuals and mild abdominal distention
are present.
� Radiographic findings can be normal or can show some mild nonspecific distention.
� Treatment is NPO with antibiotics for 3 days.