Successful Nonsurgical Management of Norovirus-Associated Necrotizing Enterocolitis in a Preterm Infant: A Case Report

Abstract

Norovirus infection has been increasingly reported in association with necrotizing enterocolitis (NEC) in preterm neonates, although the clinical spectrum remains poorly defined. We report the case of a 29-week preterm male infant who developed abdominal distension on day 35 of life, with a sepsis-like clinical presentation. Stool reverse transcriptase polymerase chain reaction confirmed Norovirus infection. Serial abdominal radiographs showed intestinal pneumatosis from day 2 of illness, consistent with Bell stage IIA NEC. The pneumatosis persisted for three days and completely resolved by day 5, without perforation or clinical deterioration. The infant was managed conservatively with bowel rest, parenteral nutrition, broad-spectrum antibiotics, and mechanical ventilation for 7 days. IVIG (500 mg/kg/day for 4 days) was administered for clinically suspected capillary leak syndrome. Enteral feeding was restarted after 8 days, and the infant was discharged at 71 days of life without gastrointestinal complications. This case highlights the heterogeneous clinical spectrum of Norovirus-associated intestinal disease and suggests that conservative management may be successful in selected clinically stable preterm infants with NEC and intestinal pneumatosis.