What clinical and radiographic findings are characteristic of NEC, and what is the initial management?

• A. Abdominal distension, feeding intolerance, bloody stools; abdominal radiographs show pneumatosis intestinalis; management includes bowel rest, broad-spectrum antibiotics, IV fluids; surgical consult if perforation or clinical deterioration.
• B. NEC presents with cough and wheeze; manage with bronchodilators.
• C. NEC shows a normal abdomen on exam.
• D. NEC is diagnosed with MRI; treat with oral feeds.

Answer: (A)

Necrotizing enterocolitis in newborns typically shows predominantly gastrointestinal signs rather than respiratory symptoms. The classic picture is abdominal distension with feeding intolerance and often bloody stools in a premature or fragile infant. On imaging, the key finding is gas within the bowel wall (pneumatosis intestinalis); you may also see portal venous gas or, if perforation develops, free air in the abdomen. Management aims to rest the bowel and treat sepsis risk: stop all enteral feeds (NPO) and decompress the GI tract, provide aggressive IV fluids and electrolyte support, and start broad-spectrum antibiotics to cover enteric organisms. Obtain cultures and monitor closely, with surgical consultation early if there is perforation or the infant deteriorates despite medical therapy. The other options don’t fit NEC because they describe respiratory symptoms, a normal abdomen, or reliance on MRI and oral feeds, which are not characteristic or appropriate for initial NEC management.