From the Research
Temperature instability in neonates should be promptly evaluated for necrotizing enterocolitis (NEC), and management should include immediate cessation of enteral feeds, gastric decompression, broad-spectrum antibiotics, and supportive care, with surgical consultation obtained early, as approximately 20-40% of infants with NEC will require surgical intervention. When evaluating a neonate with temperature instability, NEC should be considered as a potential cause, especially if accompanied by other symptoms like abdominal distension, feeding intolerance, or bloody stools. Temperature instability in NEC typically manifests as hypothermia rather than fever, though both can occur. This temperature dysregulation results from the systemic inflammatory response triggered by intestinal injury and bacterial translocation.
Management of an infant with suspected NEC includes:
- Immediate cessation of enteral feeds
- Gastric decompression via orogastric tube
- Broad-spectrum antibiotics (typically ampicillin 100-200 mg/kg/day divided q12h, gentamicin 4-5 mg/kg/day q24-48h based on gestational age, and metronidazole 15 mg/kg loading dose followed by 7.5 mg/kg q12-24h for anaerobic coverage) 1
- Supportive care including temperature regulation Serial abdominal radiographs should be obtained to monitor for pneumatosis intestinalis, portal venous gas, or pneumoperitoneum. Temperature instability may persist until the underlying inflammation resolves, typically requiring 7-14 days of antibiotic therapy.
The use of antibiotics in NEC is a crucial aspect of management, with ampicillin and gentamicin being effective in decreasing mortality and preventing clinical deterioration in NEC 1. The addition of metronidazole for anaerobic coverage may be considered in patients with surgical NEC. However, the optimal duration of antibiotic therapy is still unclear, with some studies suggesting that shorter courses of antibiotics may be sufficient 2.
Preventative strategies for NEC include the use of antenatal corticosteroids, breast milk, early initiation of trophic feeds, and judicious advancement of enteric feeds 3. Prophylactic use of probiotics may also play a role in preventing the onset of NEC, although more large-scale studies are needed to confirm this 3.
In summary, temperature instability in neonates should be promptly evaluated for NEC, and management should include immediate cessation of enteral feeds, gastric decompression, broad-spectrum antibiotics, and supportive care, with surgical consultation obtained early. The use of antibiotics in NEC is crucial, with ampicillin and gentamicin being effective in decreasing mortality and preventing clinical deterioration. Preventative strategies, including antenatal corticosteroids, breast milk, and probiotics, may also play a role in reducing the incidence of NEC.