Soru

A 10-day-old female neonate is evaluated in the neonatal intensive care unit for sudden clinical deterioration. She was born at 29 weeks of gestation via urgent cesarean delivery due to severe maternal preeclampsia. Birth weight was 1,150 g (2 lb 8 oz). Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. Over the past 8 hours, the neonate has developed temperature instability and frequent episodes of apnea and bradycardia. She is currently supported with continuous positive airway pressure. She had been tolerating advancing volumes of expressed maternal milk via an orogastric tube; however, the most recent feed yielded a large bilious gastric residual. Temperature is 35.8°C (96.4°F), pulse is 175/min, and respirations are 68/min. The abdomen is grossly distended, shiny, and erythematous with absent bowel sounds. Complete blood count shows a leukocyte count of 2,200/mm³ and a platelet count of 82,000/mm³. Arterial blood gas analysis reveals a pH of 7.26, $\text{pCO}_2$ of 38 mm Hg, and $\text{HCO}_3^-$ of 15 mEq/L. An anteroposterior abdominal radiograph demonstrates prominent, dilated bowel loops with linear radiolucencies in the intestinal wall, without free air under the diaphragm. Which of the following is the most appropriate next step in management?