Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death).

Signs and symptoms

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The condition is typically seen within days after birth, and initial symptoms include feeding intolerance, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.

Treatment

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Treatment can be either medical or surgical. Initial medical treatment includes bowel rest and decompression with intermittent gastric suction. Immediate treatment with intravenous antibiotics, including vancomycin and gentamicin will begin, as well as periodic (every 6-8 hours) abdominal x-rays monitoring for intestinal perforation. The deteriorating bowel can be visualized on X-ray as an area of "bubbling" within the wall of the bowel known as pneumatosis intestinalis. After several days, medical treatment will begin to show slow down and reversal of bowel deterioration in many cases. Where the disease is not halted through medical treatment alone, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is required. This may require a colostomy, which may be able to be reversed at a later time. Some children may suffer later as a result of short bowel syndrome if extensive portions of the bowel had to be removed.

Cause

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NEC has no definitive known cause. A contagious agent is suspected, as cluster outbreaks in neonatal intensive care units (NICUs) are seen, but it is suspected that a combination of contagion, inherent weakness in the bowel, and some timing of the initiation of oral feedings are factors. NEC is almost never seen in infants before oral feedings are initiated.

More on [ Necrotizing enterocolitis ]

Journal of Child Health Care current issue

Children's Nursing Education: Members club or street party?
Randall, D., McTaggart, I. Wed, 20 May 2009 00:00:00 -0000

Creating space: hospital bedside displays as facilitators of communication between children and nurses
Lewis, P., Kerridge, I., Jorden, C. F.C. Wed, 20 May 2009 00:00:00 -0000
Over the past decades there has been a marked change in the physical environment of children's hospitals and the configuration of individual bed spaces. No longer the stark, clinical spaces typical of years gone by, the modern hospital bed space hosts a variety of visual displays reflecting different aspects of the child's life. Building upon ideas introduced by Lewis and informed by a recent qualitative study into hospital bedside displays, this article discusses the role that displays can play in developing, deepening and enriching relationships between nurses, patients and their families in the paediatric hospital environment. It discusses the links between hospital and home, the specific function of the display of photographs and the nurse's role in `knowing' the patient and facilitating links between hospital and home. It concludes that nurses' conscious observations of a visually rich environment may make a positive contribution to the care that they deliver for the benefit of their patients and themselves.
Influences on nurses' scoring of children's post-operative pain
Simons, J., Moseley, L. Wed, 20 May 2009 00:00:00 -0000
There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart.

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