Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a serious intestinal illness in newborns with a high mortality rate. The name means damage or death to cells in the large intestine. Most cases occur in premature babies. The outcome is worse with premature babies. Babies who are born early develop NEC at a later age. The average age of onset may be up to 3 weeks in babies born before 30 weeks of gestation. The onset is 5 to 6 days for babies born after 34 weeks of gestation. Term infants develop NEC much earlier. The average age of onset is usually in the first week of life. It may start as early as the first 1 to 2 days after birth.

BABIES AT RISK FOR NECROTIZING ENTEROCOLITIS INCLUDE:

  • Premature babies with circulation difficulties.

  • Premature babies taking milk by mouth or tube feedings.

  • Babies from a difficult delivery or with lowered oxygen levels are at an increased risk. With too little oxygen, the body uses the blood in important organs necessary for life. This means the intestines receive less or no blood. This gives less oxygen to the intestinal tract.

  • Babies with too many red blood cells or who are dehydrated. Thicker blood makes oxygen transfer more difficult.

  • Babies with gastrointestinal infections.

This disease is serious because damage to the intestinal tissues can lead to a hole in the intestines. This allows bacteria and waste material (feces) to leak out into the abdomen. This causes an inflammation of the lining of the abdomen (peritonitis). It can progress rapidly. Infection can be overpowering in an infant and cause death.

CAUSES

It is not clear what causes NEC. Intestinal tissues may be weakened by too little oxygen or blood flow. When feedings are started and food moves into the weakened area, bacteria from the food can damage the tissues. The disease seems to come in clusters in nurseries. This suggests an infection. However, there does not seem to be a similar germ found in the groups of cases found to have NEC.

SYMPTOMS

Symptoms usually develop in the first 2 weeks and vary from baby to baby. Symptoms may include:

  • Abdominal distention (bloating or swelling).

  • Feedings stay in the stomach. The tummy stays bloated.

  • Baby eats poorly.

  • Bile-colored (green) fluid in stomach seen with burping or vomiting.

  • Bloody bowel movements.

  • Signs of infection, such as stopping breathing (apnea), low heart rate, and sluggishness.

DIAGNOSIS

Your caregiver will be able to tell what is wrong by taking a history, doing an exam, and performing some blood work and X-rays.

TREATMENT

Your infant's treatment depends on the severity of the problems. Treatment can include:

  • Stopping feedings and using a tube in the stomach to keep it empty.

  • Intravenous (IV) fluids for nutrition and fluid replacement. This often is long term and done through central lines.

  • Oxygen therapy, and sometimes a breathing machine is needed.

  • Antibiotic medicine as needed for infection.

  • Frequent X-rays to monitor the progress.

  • Surgery is often necessary in severe cases.

COMPLICATIONS MAY INCLUDE THE FOLLOWING:

  • Hole (perforation) in the intestine.

  • Scarring or narrowing of the intestine.

  • Problems with food absorption if large amounts of intestine must be removed.

  • Repeat surgeries may be required.

  • Severe infection.