Poor feeding and feeding intolerance in the neonate — viva

Stem

The examiner hands you the bedside record of a 12-day-old infant born at 27 weeks, on advancing expressed breast milk feeds: a gastric residual larger than the feed, bile-stained, with a fuller abdomen and three apnoeic spells. ^[1]

Examiner: What is your opening approach to this infant? ^[1]

Strong answer: This is feeding intolerance with systemic signs in an extremely preterm infant — necrotising enterocolitis until proven otherwise. The increasing and bile-stained residual, the abdominal distension, and the new apnoea are the systemic and gastrointestinal signs of early NEC. I would stop feeds immediately, pass a large-bore orogastric tube on free drainage to decompress the gut, establish intravenous access, resuscitate with isotonic crystalloid boluses titrated to perfusion, correct glucose and temperature, and start broad-spectrum empiric antibiotics. I would send an abdominal radiograph and the laboratory panel and escalate to the neonatal team. ^[2]