Report increasing abdominal distension, bilious/bloody emesis, or bloody stools.
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Test yourself first: 1 question
Question 1 of 1
A nurse caring for a preterm infant being fed enterally notes a distended abdomen, bloody stools, feeding intolerance, and lethargy. Which condition is the nurse most concerned about?
Answer: B. Necrotizing enterocolitis (NEC) is a serious bowel inflammation and necrosis, most common in preterm and formula-fed infants. Warning signs include abdominal distension, increased gastric residuals, bloody stools, feeding intolerance, and systemic signs such as lethargy and temperature instability. The nurse stops enteral feeds and notifies the provider immediately.
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What is necrotizing enterocolitis?
It occurs most often in premature, formula-fed infants and can progress to bowel perforation, peritonitis, and sepsis. Early recognition of feeding intolerance and abdominal signs is critical.
Key points to remember
- Prematurity is the greatest risk factor; human breast milk is protective compared with formula.
- Early signs include feeding intolerance, increased gastric residuals, bilious vomiting, and a distended, tender abdomen.
- Bloody stools and abdominal discoloration are concerning later signs.
- Pneumatosis intestinalis (air in the bowel wall) on abdominal x-ray is a classic diagnostic finding.
- Treatment includes stopping enteral feeds (NPO), gastric decompression, IV fluids/parenteral nutrition, and antibiotics.
- Bowel perforation may require surgical resection and possible ostomy.
Signs & symptoms
- Distended shiny abdomen, ↑ residuals
- Bloody stools, bilious vomit
- Feeding intolerance, lethargy, apnea
Nursing priorities
- Immediately stop feedings (NPO) and initiate gastric decompression with an orogastric/nasogastric tube to low suction as ordered.
- Measure abdominal girth, assess bowel sounds, and monitor for distension and tenderness.
- Administer IV fluids, parenteral nutrition, and antibiotics as prescribed.
- Avoid rectal temperatures to prevent bowel perforation.
- Promote breast milk feeding when feeds resume to reduce recurrence risk.
Labs & values
Patient teaching
- Explain to parents why feedings are stopped and replaced with IV nutrition.
- Encourage mothers to provide breast milk, which lowers NEC risk.
- Describe signs of recurrence to watch for once feeding resumes.
Red flags: report now
- Report increasing abdominal distension, bilious/bloody emesis, or bloody stools.
- Report shiny/taut or discolored abdominal wall and signs of sepsis or shock.
- Never take rectal temperatures or give enteral feeds in suspected NEC.
References
Clinical references for this topic
