Stage
Signs
Abdomen
X-ray
Treatment
I Suspected
IA
Temperature instability, apnea, bradycardia, lethargy
Gastric distention, emesis, heme-positive stool
Normal or intestinal dilation, mild ileus
NPO, 3 days antibiotics
IB
Same as above
Bloody stool
Dilation or ileus
NPO, 3 days antibiotics
II Definite
IIA Mildly ill
Same as above
Same as above, absent bowel sounds, +/− tenderness
Dilation, ileus, pneumatosis intestinalis
NPO, 7–10 days antibiotics
IIB Moderately ill
Same as above, metabolic acidosis, thrombocytopenia
Same as above, no bowel sounds, tenderness, +/− cellulitis, mass
Same as above, ascites
NPO, 14 days antibiotics
III Advanced
IIIA Intact bowel
Same as above, shock, bradycardia, apnea, respiratory acidosis, DIC, neutropenia
Same as above, peritonitis, tenderness, distention
Same as above
NPO, 14 days antibiotics, IV fluid, pressors, ventilator therapy, paracentesis
IIIB Perforation
Same as above
Same as above
Same as above, free air
Laparotomy
Adapted from: Bell ML, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7; Neu J. Necrotizing enterocolitis: the search for unifying pathogenic theory leading for prevention. Pediatr Clin North Am. 1996;43:409–32
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