Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Most frequent surgical condition in a neonate• Associated with multiple comorbidities resulting in mucosal injury of the intestine• Most commonly affecting terminal ileum and right colon +++ Epidemiology + • 1-3/1000 births and in 30/1000 of low-birth-weight babies +++ Symptoms and Signs + • Abdominal distention• Feeding intolerance• Bilious emesis• Occult or gross blood in stool• Abdominal tenderness• Abdominal wall edema, crepitus, or discoloration (suggest perforation)• Temperature instability• Apnea• Bradycardia +++ Laboratory Findings + • Hypoxemia• Acidosis• Thrombocytopenia +++ Imaging Findings + • Abdominal x-ray: Shows pneumatosis intestinalis from 20% to 98% of time, thickened loops of bowel, ascites, and portal venous gas; possible pneumoperitoneum +++ Rule Out + • Perforation + • History and physical exam• ABG measurements• CBC• Electrolytes• Abdominal x-ray +++ Surgery + • Exploratory laparotomy if patient decompensates or does not improve after 24-72 hours of medical management, pneumoperitoneum, portal venous gas, abdominal wall erythema, or crepitus; resection of necrotic bowel, proximal enterostomy, and distal mucous fistula +++ Medications + • 90% can be managed medically with NG decompression, bowel rest, broad-spectrum antibiotics, and correction of other comorbid conditions +++ Complications + • 20-40% complication rate including leak, stomal necrosis, fistula formation, and stricture +++ Prognosis + • Mortality rate, 20-40% +++ References ++Andorsky DJ et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr. 2001;139:27. [PubMed: 11445790] ++Noble HG, Driessnack M: Bedside peritoneal drainage in very low birth weight infants. Am J Surg 2001;181:416. [PubMed: 11448432] ++Moss RL et al: Laparotomy compared with peritoneal drainage in infants with necrotizing enterocolitis and intestinal perforation. New Engl J Med 2006;354:2225. [PubMed: 16723614] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth