Stage Classification Systemic Signs Intestinal Signs Radiologic Signs

▪ temperature instability ▪ elevated residuals

Suspected NEC
1a
▪ apnea ▪ mild abdominal distension ▪ normal or intestinal dilation
▪ bradycardia ▪ emesis ▪ mild ileus
▪ lethargy ▪ guaiac-positive stools
1b Suspected NEC 1a ▪ Bright-red blood per rectum 1a
1b plus: ▪ intestinal dilation
Proven NEC
2a 1a ▪ absent bowel sounds ▪ ileus
– mildly ill
▪ +/- abdominal tenderness ▪ pneumatosis intestinalis
2a plus:
2a plus: 2a plus:
Proven NEC ▪ definite abdominal tenderness
2b ▪ mild metabolic acidosis ▪ portal vein gas
– moderately ill ▪ +/- abdominal cellulitis
▪ mild thrombocytopenia ▪ +/- ascites
▪ +/- right lower quadrant mass
2b plus:
▪ hypotension
2b plus:
Advanced NEC ▪ bradycardia
▪ signs of generalized peritonitis 2b plus:
3a – severely ill, bowel ▪ severe apnea
▪ marked tenderness ▪ definite ascites
intact ▪ respiratory & metabolic acidosis ▪ abdominal distension
▪ DIC
▪ neutropenia
Advanced NEC
3a plus:
3b – severely ill, bowel 3a 3a
▪ pneumoperitoneum
perforated