Clinical Communications: Pediatrics| Volume 58, ISSUE 6, e255-e258, June 2020

Download started.


Abdominal Distention and Emesis in a Term Neonate



      Necrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10–15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.

      Case Report

      A 24-day-old term male infant presented to the Emergency Department (ED) with emesis. The infant was ill-appearing with a tense abdomen and had significant tachycardia and hypotension. The patient was immediately volume resuscitated and started on empiric antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis. Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed tomography scans were obtained, which were nondiagnostic. The patient was taken to the operating room for an exploratory laparotomy after continued clinical deterioration and was diagnosed with NEC totalis and passed away within 6 days.

      Why Should an Emergency Physician Be Aware of This?

      This case demonstrates an uncommon presentation of NEC in an otherwise healthy term neonate without any known risk factors. The diagnosis of NEC is challenging because imaging studies may be inconclusive, particularly early in the clinical course. Regardless of the etiology, all infants who present to the ED with signs and symptoms of severe gastrointestinal distress should be treated with basic emergency care, including rapid fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical consultation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Neu J.
        • Walker W.A.
        Necrotizing enterocolitis.
        N Engl J Med. 2011; 364: 255-264
        • Ostlie D.J.
        • Spilde T.L.
        • St Peter S.D.
        • et al.
        Necrotizing enterocolitis in full-term infants.
        J Pediatr Surg. 2003; 38: 1039-1042
        • Christensen R.D.
        • Lambert D.K.
        • Baer V.L.
        • et al.
        Necrotizing enterocolitis in term infants.
        Clin Perinatol. 2013; 40: 69-78
        • Hodzic Z.
        • Bolock A.M.
        • Good M.
        The role of mucosal immunity in the pathogenesis of necrotizing enterocolitis.
        Front Pediatr. 2017; 5: 40
        • Denning T.L.
        • Bhatia A.M.
        • Kane A.F.
        • et al.
        Pathogenesis of NEC: role of the innate and adaptive immune response.
        Semin Perinatol. 2017; 41: 15-28
        • Berseth C.L.
        Feeding strategies and necrotizing enterocolitis.
        Curr Opin Pediatr. 2005; 17: 170-173
        • Cantey J.B.
        • Pyle A.K.
        • Wozniak P.S.
        • et al.
        Early antibiotic exposure and adverse outcomes in preterm, very low birth weight infants.
        J Pediatr. 2018; 203: 62-67
        • Patel R.M.
        • Knezevic A.
        • Shenvi N.
        • et al.
        Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight Infants.
        JAMA. 2016; 315: 889-897
        • McElhinney D.B.
        • Hedrick H.L.
        • Bush D.M.
        • et al.
        Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes.
        Pediatrics. 2000; 106: 1080-1087
        • Wiswell T.E.
        • Robertson C.F.
        • Jones T.A.
        • et al.
        Necrotizing enterocolitis in full-term infants. A case-control study.
        Am J Dis Child. 1988; 142: 532-535
        • Overman R.E.
        • Criss C.N.
        • Gadepalli S.K.
        Necrotizing enterocolitis in term neonates: a different disease process?.
        J Pediatr Surg. 2019; 54: 1143-1146
        • Lin P.W.
        • Stoll B.J.
        Necrotising enterocolitis.
        Lancet. 2006; 368: 1271-1283
        • Fleisher G.
        • Ludwig S.
        • Henretig F.
        Textbook of pediatric emergency medicine.
        5th edn. Lippincott Williams & Wilkins, Philadelphia2005
        • Wertheimer F.
        • Arcinue R.
        • Niklas V.
        Necrotizing enterocolitis: enhancing awareness for the general practitioner.
        Pediatr Rev. 2019; 40: 517-527
        • Fitzgibbons S.C.
        • Ching Y.
        • Yu D.
        • et al.
        Mortality of necrotizing enterocolitis expressed by birth weight categories.
        J Pediatr Surg. 2009; 44: 1072-1075
        • Sawaya R.D.
        • Chedid I.
        • El Majzoub I.
        Pediatric sepsis and septic shock.
        Pediatr Emerg Med Rep. 2018; 23