6. Necrotizing Enterocolitis & Infants of Diabetic Mothers

what is necrotizing enterocolitis?

ischemic inflammation of the bowel that can cause necrosis and perforation

which newborns are most vulnerable to necrotizing enterocolitis?

premature newborns with immature intestines

when does necrotizing enterocolitis most often develop?

days 3–12

what findings suggest necrotizing enterocolitis?

• abdominal distension

• feeding intolerance or increased residuals

• bilious vomiting

• bloody stools

what feeding helps prevent necrotizing enterocolitis? *

early colostrum or breast milk

what is the immediate feeding intervention for suspected necrotizing enterocolitis?

stop feeds and keep NPO

how is gastric decompression provided in necrotizing enterocolitis?

NG or OG tube to prescribed suction

what medications treat infection in necrotizing enterocolitis?

broad-spectrum IV antibiotics

how is nutrition provided during bowel rest for necrotizing enterocolitis?

TPN and lipids, parental

how often should abdominal circumference be measured in necrotizing enterocolitis?

every 6–8 hours

what treatment is needed if necrotizing enterocolitis causes bowel perforation?

surgical removal of damaged bowel, possibly with an ostomy

what long-term problems can follow bowel resection for necrotizing enterocolitis?

• short bowel syndrome

• malabsorption

• ongoing nutrition (TPN) or ostomy support

why can maternal diabetes cause fetal macrosomia?

excess maternal glucose stimulates fetal insulin production

• insulin promotes growth

why are infants of diabetic mothers at risk for hypoglycemia after birth?

maternal glucose supply stops, but the newborn’s insulin remains high

• causes glucose less than 40-50 within 1-4 hours

when can hypoglycemia develop in an infant of a diabetic mother?

within the first 1–4 hours after birth

what newborn blood glucose level requires concern for hypoglycemia?

below 50 mg/dL

what findings suggest newborn hypoglycemia?

• jitteriness or tremors

• lethargy

• weak suck

• hypothermia

• tachypnea

• seizures in severe cases

what is the first assessment when newborn hypoglycemia is suspected?

immediate capillary blood glucose

what is the initial treatment for a stable hypoglycemic newborn who can feed safely?

immediate feeding

what may be given if feeding does not correct hypoglycemia in a stable newborn?

40% dextrose gel as prescribed, or IV D10

what IV solution is used when newborn hypoglycemia requires IV treatment? *

D10

why are infants of diabetic mothers at increased risk for respiratory distress syndrome?

high fetal insulin delays surfactant development

what metabolic or hematologic problems are infants of diabetic mothers at risk for?

• hypoglycemia

• respiratory distress syndrome

• hypocalcemia

• polycythemia

• hyperbilirubinemia

common fetal risks to mother is type 1 diabetes

• neural tube defects

• cardiac defects

• IUGR