A preterm infant on gavage feeds with a bloody stool presents for assessment. Which action is appropriate?

• A. Institute contact precautions.
• B. Obtain a rectal temperature.
• C. Assess for abdominal distention.
• D. Decrease the amount of the feeding.

Answer: (C)

When a preterm infant on gavage feeds presents with bloody stool, the priority is to assess the abdomen for signs of necrotizing enterocolitis (NEC). Abdominal distention is a critical early finding of NEC, indicating possible inflammation or compromised bowel. By palpating and inspecting the abdomen, and noting changes in girth, tenderness, and bowel sounds, you can detect distention early. This assessment guides urgent actions, such as holding enteral feeds and alerting the provider for further evaluation, imaging, or treatment. The other options don’t address this urgent concern directly: precautions depend on infection status, a rectal temperature is not the immediate issue here, and reducing feeding quantity without evaluating the abdomen could mask or delay NEC progression. Focusing on abdominal distention helps you recognize a potentially life-threatening complication and respond promptly.