Phased nutritional management and growth recovery following surgical necrotising enterocolitis in a preterm infant: a case report

Abstract

Introduction: Necrotising enterocolitis (NEC) remains a leading cause of morbidity and mortality among preterm infants. Nutritional management is central to survival and recovery, but is complicated by bowel rest, surgical resections and malabsorption.
Case presentation: A male infant born at 29 weeks’ gestation (birthweight 1 150 g) developed Bell’s stage IIB NEC on day 20 of life. He required prolonged parenteral nutrition (PN) and ileal resection with ileostomy, preserving 130 cm of small bowel. PN was continued postoperatively with cautious trophic expressed breast milk (EBM) feeds. Enteral nutrition was advanced
gradually, later including semi-elemental formulas to manage malabsorption and high stoma output. Stoma reversal occurred on day 82, and full enteral autonomy was achieved by day 93. Despite severe growth restriction (< −3 z-score) on discharge, the infant demonstrated improved growth velocity (18 g/kg/day) following stoma reversal.
Discussion: This case illustrates phased nutritional management following surgical NEC. PN provided metabolic stability, while
early cautious enteral feeding promoted intestinal adaptation.

Keywords: necrotising enterocolitis, surgery, preterm infants, nutritional management