What are the key clinical signs and symptoms to consider when diagnosing necrotizing enterocolitis in neonates?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025Updated: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When diagnosing necrotizing enterocolitis (NEC) in neonates, several key clinical signs and symptoms should be considered .


Early clinical signs of NEC can often be non-specific, similar to other neonatal infections, and may include general signs such as lethargy, poor feeding, and temperature instability .


More specific gastrointestinal signs commonly observed include abdominal distension, bilious vomiting, bloody stools, and increased gastric residuals .


Systemic signs that indicate a more severe presentation or progression of NEC can involve apnea and bradycardia .


These clinical features are crucial for the initial suspicion and diagnosis of NEC .

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