<prompt> A neonate is suspected to be suffering from necrotizing enterocolitis NEC. On further examination and investigation, he is diagnosed to he Bells stage I NEC. The management of choice would be:Laparotomy and proceedInsertion of bilateral pelvic drainsConservative management with IV fluids and antibioticsInitial conservative management and laparotomy after 24 hours  <response>: Ans. c. Conservative management with IV fluids and antibiotics Ref: Nelson 19e p601The management of choice for Bells Stage I necrotizing enterocolitis is conservative management with IV fluids and antibiotics.Treatment of Bells Stage I Necrotizing Enterocolitis: NPO, IV fluids and Antibiotics for 3 days.A very preterm baby on 30 mLkg of enteral feeding developed sudden severe abdominal distension with visible bowel loops on day 6 of life. The baby also showed temperature instability ami lethargy. X-ray of the abdomen showed portal venous gas. The staging of NEC is 2b.The severity, radiology and management of Necrotizing enterocolitis is best exemplified by the Modified Bells staging criteria. According to Modified Bells staging criteria pneumatosis portalis Presence of gas in portal vein is suggestive of stage 2b.Modified Bells Staging Criteria for Necrotizing EnterocolitisStageClassificationSystemicAbdominalRadiologicalTreatmentIASuspected NECTemperature instability, apnea, bradycardia, lethargyAspirates, mild abdominal distension, ve fecalNormalmild intestinal dilationmild ileus, occult bloodNPO, IV fluidsAntibiotics x 3 daysIBSuspected NECSame as IAFresh blood per rectumSame as IASame as IAIIAProven NEC, mildly illSame as IASame as IA absent bowel sounds - abdominal tendernessIntestinal dilation, ileus, pneumatosis intestinalisQNPO, Antibiotics x 7-10 daysMBProven NEC, moderately illSame as IA mild metabolic acidosis mild thrombocytopeniaSame as IA absent bowel sounds, definite tendernessQ, abdominal cellulitis, right lower quadrant massSame as IIA portal venous gasQ - ascitesNPO, Antibiotics x 14 daysIMAAdvanced NEC, severely illQ,bowel intactSame as IIB hypotension, respiratory acidosis, neutropenia, DICSame as IIB suggestive of peritonitis, marked abdominal tenderness, marked abdominal distentionSame as IIA definite ascitesQNPO,Antibiotics x 14 days Fluid resuscitation ionotropic support ventilator therapy ParacentesisIIIBAdvanced NEC, severely ill, bowel perforatedQSame as IIIASame as IIIASame as IIB pneumoperitoneumQSame as IIIA surgery 