Tip 28: NEC stages

The modified Bell’s stages for NEC are:

1 (suspected) – general features of sepsis, mild abdo distension, increased NG asp, AXR: normal/mild ileus.

2a (confirmed) – prominent abdo distension, bloody stools, mild abdo tenderness, AXR: thickened bowel wall, focal pneumatosis.

2b (confirmed severe) – thrombocytopenia, mild met acidosis, palpable abdo loops, tenderness, AXR: widespread pneumatosis, ascites or portal gas.

3a (advanced) – septic shock incl. DIC, peritonitis.

3b (advanced plus perforation) – AXR: pneumoperitoneum.


Bell, M. J., Ternberg, J.L., Feigin R.D., et al., 1978. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg., 187: 1 – 7.

Kliegman, R.M., Walsh, M.C, 1987. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Probl Pediatr; 17(4): 243–288.

Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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