Update Course Rewind 2025: Updates in NEC Management
With Dr. Augusto Zani & Dr. Simon Eaton · hosted by Dr. Lizzie Lee & Dr. Todd Ponsky
Cued at 3:07 · stops at 3:52 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about necrotizing enterocolitis
same diagnosisDive deeper → Necrotizing Enterocolitis (20 items)Podcast
Necrotizing Enterocolitis with Dr. Gail Besner
46 min · Published May 2017
Video
STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial
57 s · Published Apr 2025
Podcast
Necrotizing Enterocolitis with Dr. Gail Besner
46 min · Published May 2017
Video
Necrotizing Enterocolitis
35 min · Published Nov 2018
Video
Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...
55 s · Published Jul 2026
Video
Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC) - Validation in a Large Animal Model
59 s · Published Apr 2025
Only a few other public items share this expert — go deeper there →
What the experts said
Abdominal X-rays for NEC have high specificity but very low sensitivity, with studies showing sensitivity between 13 and 25%
Ultrasound can assess bowel wall thickening, thinning, perfusion, peristalsis, intra-abdominal contents, peritoneum, and liver
High-risk ultrasound findings for bowel perforation include pneumoperitoneum, focal fluid collections, and complex fluid
Intermediate-risk ultrasound findings include increased bowel wall echogenicity, absent perfusion, portal venous gas, and bowel thinning and thickening
The majority of surgeons would perform laparotomy rather than drain placement for perforated NEC
Babies are sick post-operatively whether you perform anastomosis or not
In NEC, diseased bowel is a symptom or result of the illness, not the cause of the illness
The disease still progresses even after resection, which is the problem of operating too early
In stable babies where approximately 10 cm of necrotic segment is removed for source control, they do not necessarily do poorly afterwards and there is long-term benefit
Data shows primary anastomosis is better than stoma in appropriate cases
Hemodynamic markers to guide second-look decisions include lactate correction, thrombocytopenia correction, and weaning off inotropes
The SAT trial was a randomized controlled trial where final eligibility decision was made by the surgeon during laparotomy based on hemodynamic stability
A systematic review and meta-analysis by Bonnie Jasani from Toronto Sick Kids shows the evidence for mucous fistula refeeding is not strong so far
There is an ongoing randomized controlled trial of mucous fistula refeeding measuring time to full enteral feeds
A recent paper in Journal of Surgical Research shows early stoma closure (before 8 weeks) appears to be safe
The early stoma closure study was very underpowered, and in the less-than-8-weeks group there were 2 infants who had repeat episodes of NEC
There is an ongoing preparation for a randomized trial on stoma closure timing in the UK (SKIN mixed methods study)
Surgeons need to be prepared to have some negative laparotomies when clinical suspicion is high despite equivocal imaging
For every 10 babies with surgical NEC, an X-ray might only catch one or two in the early stages (based on 13% sensitivity)
A 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and silent fluid collections that X-ray misses
The benefit of primary anastomosis may not be seen in immediate survival but appears in the long run
In clip-and-drop technique, surgeon removes necrotic segment, staples the ends, and returns in 24-48 hours to check gut hemodynamics before committing to stoma or anastomosis
In the SAT trial, mortality was similar between primary anastomosis and stoma groups
Babies who received primary anastomosis got off parenteral nutrition significantly sooner than those with stoma
Babies with primary anastomosis were able to return to enteral feeds more quickly and had fewer intestinal complications than those with stoma
Mucous fistula refeeding involves recycling upper stoma output into the lower bowel to keep it healthy