خديج وُلد في الأسبوع ٢٩، عمره ١٠ أيام، بدأ تغذية بالحليب الصناعي عبر الأنبوب. صار بطنه منتفخاً ولامعاً، وبقايا التغذية خضراء، وفي البراز دم، وتكررت عنده نوبات توقف تنفس. الحرارة غير مستقرة. ما الأرجح وما الإجراء الأول؟

A baby born at 29 weeks, now 10 days old, has started formula feeds via tube. His abdomen is now distended and shiny, aspirates are green, there is blood in the stool and recurrent apnoeas. Temperature is unstable. What is most likely and the first action?

1. Simple constipation needing a suppository and larger milk feeds
2. Infant colic managed with massage and burping
3. Normal reflux needing only smaller feeds
4. NEC: stop feeds, decompress the stomach, notify the provider

Answer: D) NEC: stop feeds, decompress the stomach, notify the provider. Distension, bilious aspirates, bloody stool and instability in a fed preterm infant indicate NEC. Stop feeds, decompress, give fluids and antibiotics and obtain X-rays.