Contrast enemas after necrotising enterocolitis: a case for prophylaxis?

During a 4-year period 9 out of 35 patients deteriorated following a contrast enema after necrotising enterocolitis (NEC). Two developed Klebsiella septicaemia with one subsequent death. Following the latter two cases the paediatric surgeons instituted intravenous prophylactic antibiotics (benzyl penicillin, metronidazole, gentamicin) prior to contrast enemas post-NEC. Of the factors examined only the presence a long line in-situ or history of previous perforation demonstrated any increased risk with regard to clinical deterioration post-examination.