Infants with a history of bowel surgery can develop adhesions that present with intestinal obstruction This could include patients with a history of congenital diaphragmatic hernia, omphalocele, gastroschisis, intestinal atresia, or meconium syndrome, as well as patients with a history of NEC Necrotizing Enterocolitis CLINICAL PEARLS AND PITFALLS Although necrotizing enterocolitis (NEC) is most common in the premature infant, up to 10% of cases occur in the term infant Term infants with NEC often have specific risk factors that increase the risk of intestinal asphyxia or altered gut perfusion Infants with a history of NEC can present with small bowel obstruction months after resolution of NEC Current Evidence NEC is a gastrointestinal emergency where progressive mucosal injury and inflammation result in bowel necrosis While the incidence of NEC is inversely proportional to gestational age, up to 10% of cases occur in the term neonate Up to a third of cases of NEC result in death, and postsurgical survivors have an increased risk of developing short-bowel syndrome While the exact etiology remains unknown, elements of ischemic injury, intestinal hypoxia, coagulation necrosis, acute or chronic inflammation, and bacterial overgrowth of the GI tract are all likely contributors Term infants with a history of intrauterine growth restriction or SGA, congenital heart disease, meningomyelocele, and gastroschisis have increased risk of developing NEC Similarly, term and preterm infants with a history of polycythemia, exchange transfusion, umbilical catheterization or asphyxia, are also at increased risk of developing NEC Goals of Treatment The primary goal of treatment is early recognition of NEC so that supportive therapy can ameliorate bowel necrosis Treatment includes fluid resuscitation and blood pressure support, bowel rest, and broad-spectrum antibiotics that cover enteric bacteria Acidosis, anemia, and thrombocytopenia should be corrected Evidence of intestinal perforation (up to 50% of cases) requires surgical intervention with either a drain procedure or laparotomy Patients with necrotic bowel may present without perforation but worsening abdominal discoloration