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NEC (Stage of NEC (IA Suspected (Symtometic signs (Temperature instability…

- - - - Temperature instability, apnea, bradycardia, lethargy
    - - Gastric retention, abdominal distention, emesis, heme-positive stool
    - - Normal or intestinal dilation, mild ileus
    - - NPO, antibiotics x 3 days
  - - - Same IA
    - - Grossly bloody stool
    - - Same IA
    - - Same IA
  - - - Same IA,IB , plus absent bowel sounds
        with or without abdominal tenderness
    - - Same IA,IB
    - - NPO, antibiotics x 7 to 10 days
    - - Intestinal dilation, ileus,
        pneumatosis intestinalis
  - - - Same IA,IB, plus absent bowel sounds, definite tenderness, with or without abdominal cellulitis or right lower quadrant mass
    - - Same IA,IB, plus mild
        metabolic acidosis and
        thrombocytopenia
    - - NPO, antibiotics x 14 days
    - - Same as IIA, plus ascites
  - - - Same as above, plus signs of peritonitis, marked tenderness, and abdominal distention
    - - Same as IIA, plus ascites
    - - NPO, antibiotics x 14 days, fluid resuscitation, inotropic support, ventilator therapy, paracentesis
    - - Same as IIB, plus hypotension, bradycardia, severe apnea, combined respiratory and metabolic acidosis,DIC, and neutropenia
  - - - Same as IIIA
    - - Same as above, plus pneumoperitoneum
    - - Same as IIIA
    - - Same as IIA, plus surgery
- - - - Pospatum
      - intrapatum
- - - - Endogenous inflammatory mediator
        
        Complement
        
        Prostaglandin
        
        Tumor necrosis factor(TNF)
        
        Platelet activating factod(PAF)
        
        Leukotriene C4
        
        Norepinephrine
        
        Mesenteric vasoconstriction
    - - Coagulation or ischemia
        
        Bowel dilation ,gas in bowel
        ,bleeding or discharge in bowel
        
        Bowel perforation