How should feeding be managed when NEC is suspected in a neonate?

• A. Hold all enteral feeds, decompress stomach with an NG tube, provide IV fluids and parenteral nutrition as indicated, and obtain diagnostic imaging.
• B. Continue enteral feeds with antibiotics.
• C. Switch to formula feeds immediately.
• D. Increase feeds to flush the gut.

Answer: (A)

When NEC is suspected, the priority is to rest the gut, support circulation, and evaluate the extent of disease. Hold all enteral feeds to prevent further intestinal injury and gas production. Decompressing the stomach with an NG tube lowers intraluminal pressure and distension, which helps improve perfusion and reduces the risk of progression. Provide IV fluids and parenteral nutrition as indicated to maintain hydration, electrolyte balance, and nutritional needs while the bowel is not being fed. Obtain diagnostic imaging to look for NEC signs such as pneumatosis intestinalis, portal venous gas, or perforation, which guides treatment decisions and the need for surgical consultation. In many protocols, broad-spectrum antibiotics are started as part of NEC management, but the foundational steps—holding feeds, decompressing, and providing IV fluids and parenteral nutrition with imaging—are essential.