Pneumatosis intestinalis described in necrotizing enterocolitis Bell stage II A in a preterm ELBW neonate – Case report

Background. Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disorder that primarily affects premature and low birth weight infants. It is characterized by intestinal inflammation and necrosis, with potentially rapid clinical deterioration. Aim. We describe the case of an extremely low birth weight (ELBW) preterm male infant diagnosed with Bell stage II A NEC presenting with pneumatosis intestinalis. Results. The diagnosis was supported by leukopenia (4,710/µL), elevated inflammatory markers, and abdominal X-ray findings of marked aerocolia and pneumatosis intestinalis. Management included endotracheal intubation, mechanical ventilation, total parenteral nutrition, and broad-spectrum intravenous antibiotics (imipenem/cilastatin, amikacin, and metronidazole), along with adjunctive pentoxifylline and human albumin. Gastric decompression via nasogastric tube was performed, and enteral feeding was suspended. Anemia was corrected with red blood cell transfusion. The patient improved under conservative treatment, allowing reintroduction of breast milk feeding after 72 hours. Conclusions. This case highlights the importance of early diagnosis and prompt supportive management in NEC. Conservative treatment can be effective in selected ELBW infants with Bell stage II A disease, potentially avoiding surgical intervention.