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OASCN Resources | Necrotizing Enterocolitis (NEC)

These resources were developed by the OASCN Collaborative between 2021-2022.

Relevant Didactics:

  • Naming the Problem That Underpins “Rule-out Sepsis” - The Need for Bayesian Thinking  (Joseph Schulman): Slides | Video

Relevant Learning Points:

Learning Point #29: Vancomycin is unnecessary as empiric therapy for NEC, and most cases of LOS; it can be safely eliminated. If a CLABSI is being considered AND MRSA is a big problem in your NICU then empiric vancomycin might be reasonable.

Learning Point #30: Anaerobic coverage for NEC not required; consider for known perforation or severe disease.

Learning Point #31: Treatment duration for mild-moderate NEC can be 5-7 days. For more severe cases 10 days may be reasonable.

Learning Point #32: Piperacillin-tazobactam (Zosyn) may be overkill for empiric (medical) NEC coverage and doesn’t get into CSF well. Non-Zosyn-containing regimens are not inferior.

Relevant References: 

Cotten CM for NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009;123:58.

Downard CD et al. Treatment of necrotizing enterocolitis: An American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatric Surgery 2012;47:2111.

Gill MA et al. Antibiotics in the medical and surgical treatment of necrotizing enterocolitis. A systematic review. BMC Pediatr 2022 Jan 27;22(1):66. doi: 10.1186/s12887-022-03120-9.

Smith MJ et al. Antibiotic safety and effectiveness in premature infants with complicated intraabdominal infection. PIDJ 2021;40:550-55.

Autmizquine J et al. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics 2015;135:e117-25