Necrotizing Enterocolitis

An discussion of the medical and operative management of necrotizing enterocolitis between Todd Ponsky, MD and Gail Besner, MD. Dr. Besner is a H. William Clatworthy Professor of Pediatric Surgery, Chief of the Department of Pediatric Surgery, Principal Investigator of the Center of Perinatal Research, and Associate Director of the Pediatric Surgery Training Program at Nationwide Children's Hospital. Table of Contents 00:00:00 Introduction 00:02:41 Work-up of NEC 00:04:02 Medications associated with NEC 00:05:24 Physical Examination 00:07:04 Laboratory Work 00:08:44 Imaging studies 00:09:15 When to Operate on NEC 00:10:45 Medical Management of NEC 00:12:23 Antibiotic regimen 00:13:19 Frequency of imaging studies 00:13:55 Length to continue medical management 00:14:39 Stricture after NEC 00:15:43 When to operate after medical management without absolute indication 00:17:11 Peritoneal drain versus laparotomy 00:19:42 Randomized control trials comparing peritoneal drain and laparotomy 00:22:51 How to choose between peritoneal drain and laparotomy 00:26:03 Peritoneal drain placement technique 00:28:12 Operating after placement of a peritoneal drain 00:29:34 Management of patient after peritoneal drain placement 00:30:59 Laparotomy technique 00:33:39 Operative management of focal necrotic area 00:34:41 Creating a stoma 00:36:50 Management of Diffuse NEC 00:37:58 Management of skip lesions 00:39:21 When to reverse the stoma 00:40:34 Re-feeding mucous fistula 00:42:04 Management of NEC totalis 00:44:05 Management of tension pneumoperitoneum Intro and outro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/