Necrotizing Enterocolitis Differential Diagnoses

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Diagnostic Considerations

Necrotizing enterocolitis (NEC) is a clinical diagnosis that can be subtle at its onset. Early symptoms frequently mimic more common clinical conditions, such as poor gastric motility and benign feeding intolerance. Retrospective review of the earliest clinical signs once the diagnosis is apparent can seem misleadingly clear, even though the prospective assessment was much less straightforward. Laboratory and radiographic evidence can bolster a clinical impression of benign conditions.

Not infrequently, free air is noted on an abdominal radiograph of a premature infant, either as an incidental finding on imaging performed for other reasons or during an initial evaluation for abdominal pathology. Spontaneous intestinal perforation (SIP) can be distinguished from NEC by its lack of systemic involvement, absence of other clinical signs common to bowel perforation, and higher rate of survival. [30] SIP is further distinguished by its earlier onset in babies of smaller birth weight and more extreme prematurity. [31] Associations have been identified between SIP and indomethacin, [30] dexamethasone, [32] and systemic candidiasis. [31]

Conditions to consider in the differential diagnosis of NEC include the following:

  • Hypoplastic left heart syndrome

  • Intestinal malrotation

  • Intestinal volvulus

  • Bacterial meningitis

  • Neonatal sepsis

  • Omphalitis

  • Prematurity

  • Urinary tract infection

  • Volvulus

Differential Diagnoses