and distention and persistent thrombocytopenia and acidosis Exploratory laparotomy is often indicated in this group to identify and remove the necrotic segment Clinical Considerations Clinical Recognition The signs associated with NEC are often nonspecific and can include hematochezia, emesis or feeding intolerance, abdominal distention, lethargy, and apnea and bradycardia In advanced disease, there is also tachycardia, abdominal tenderness with discoloration, respiratory failure, and shock Laboratory analysis may reveal neutropenia, thrombocytopenia, metabolic acidosis, and/or hyponatremia Triage Considerations Neonates with suspected NEC should be triaged urgently as the disease can progress rapidly to respiratory failure and shock Clinical Assessment The most common presenting sign in the neonate is emesis The examination may reveal a distended abdomen; however signs of peritonitis or shock are often late findings and may not be present The diagnosis is made by the identification of pneumatosis intestinalis, portal venous gas, or pneumoperitoneum on abdominal radiograph ( Fig 96.40 ) In mild cases, plain radiographs may reveal signs of ileus but no evidence of pneumatosis; in these cases, portal venous gas may be appreciated by US Management There is no specific treatment for NEC other than supportive therapy Bowel rest is indicated, with gastric decompression Fluid resuscitation is often required, and in advanced disease, may also require blood pressure support Due to the mucosal injury and bacterial translocation of intestinal flora, broad-spectrum antibiotics are indicated Blood cultures should be drawn prior to the initiation of antibiotics, and will be positive in approximately one-third of cases Two-view radiographs of the abdomen are indicated to detect pneumatosis and/or pneumoperitoneum Laboratory evaluation should include blood cultures, complete blood count, basic metabolic profile, blood gas, and, in severe cases accompanied by disseminated intravascular coagulation, coagulation studies Surgical intervention is warranted if there is evidence of intestinal perforation or if there is worsening of clinical symptoms that suggest a necrotic segment Bowel necrosis is often accompanied by persistent thrombocytopenia and acidosis, with systemic signs of respiratory failure and shock