A Workbook Exercise on Necrotizing Enterocolitis
Fredric D. Burg MD1
Richard A. Polin MD2
1 Associate Dean for Academic Programs, University of Pennsylvania School of Medicine, Philadelphia
2 Assistant Professor of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania
Readers will immediately notice that the following article departs from the usual style in medical journals. We all recognize that active learning is far better than passive, but this is difficult to achieve in the usual journal article. Drs Burg and Polin have developed a sequential workbook approach in the following article which will require your active participation. We believe that it will result in better learning, but would appreciate reader comment.
R.J.H.
The following are a series of exercises aimed to help you in: (1) identifying the factors that cause necrotizing enterocolitis (NEC); (2) Explaining the pathophysiology of NEC; (3) developing a proper approach to diagnosing necrotizing enterocolitis in the neonate; and (4) managing a newborn with this disease.
EXERCISE 1
Factors That Contribute to Development of Necrotizing Enterocolitis
Please read through the following case history.
K.W. was a 1,600-gm girl delivered to a 17-year-old primigravida by emergency cesarean section for fetal distress at 31 weeks' gestation. Apgar scores at one and five minutes were 2 and 5. The infant was given 3 mEq of sodium bicarbonate through an umbilical vein (UV) catheter in the delivery room and then intubated. Following admission to the intensive care nursery an umbilical arterial (UA) catheter was inserted and positioned at L-1.
