Necrotizing Enterocolitis (NEC)

Diagnosis of NEC is based on a combination of clinical, laboratory, and radiologic findings. Among these, radiologic signs play a critical role in assessing disease severity. Key imaging findings include:

• Pneumatosis intestinalis (air within the bowel wall)
• Portal venous gas
• Free intraperitoneal air (suggesting  bowel perforation)
• Fixed, dilated bowel loops
• Gasless abdomen

Ultrasound may also be helpful in early or unclear cases.

The Modified Bell's Criteria remains the most widely used clinical staging system for NEC. More recently, machine learning–based diagnostic tools are being explored to improve diagnostic accuracy.

Initial management of NEC focuses on medical stabilization and supportive care. This typically includes:

• Discontinuation of enteral feeding
• Gastric decompression
• Broad-spectrum antibiotics
• Correction of metabolic acidosis, anemia, and thrombocytopenia

Advanced supportive measures, including mechanical ventilation, vasopressor support, and fluid resuscitation, may be required for hemodynamic stabilization.

Surgical intervention is indicated when medical management fails or when intestinal perforation is suspected or confirmed. Surgical options include:

• Primary peritoneal drainage (PPD)
• Laparotomy with resection of necrotic bowel

Approximately 30–40% of NEC cases require surgical management. The only absolute indication for surgery is pneumoperitoneum, the presence of free air in the abdominal cavity.