ABSTRACT
The overall medical condition o f the infant with necrotizing enterocolitis who requires operation must be optimized prior to surgery. These infants frequently are in shock. Adequate intravenous lines should be established, and the infant should be given fluid to restore the intravascular volume to optimal levels. An appropriately-posi tioned umbilical artery catheter or a peripheral arterial line can be o f great help in the management o f the infant. The urine output should be 1.5-2.0 cc/kg/h. This can be achieved using crystalloid, packed cells, and fresh frozen plasma (FFP), as indicated by hematologic indices. Packed cells, FFP and platelets should be ordered and ready for use during surgery. The patient should be started on broad spectrum antibiotics to include coverage o f gram negative enterics and anaerobic bacteria, if these have not already been started. The patients oxygenation and ventilation should be optimized: with few exceptions all infants will be endotracheally intubated in the newborn intensive care unit; hypoxia and hypercarbia worsen the patients overall tolerance o f anesthesia, and perhaps the course o f the necro tizing enterocolitis itself. These should be corrected prior to moving to the operating room. The patient should be maintained under a radiant warmer in order to avoid hypothermia. A dose o f gammaglobulin may be a benefit, and should be considered.
