Neonatal Necrotizing Enterocolitis. Therapeutic Decisions Based upon Clinical Staging

On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.’ Bell's staging system was conceived in order to guide a clinical treatment protocol for neonates with a diagnosis of NEC. The staging was modified by Walsh and Kliegman to divide each stage into two, differentiating on additional symptoms such as fresh rectal bleeding (IA/IB) and presence of pneumoperitoneum (IIIA/IIIB).