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Necrotizing Enterocolitis
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Necrotizing Enterocolitis

(NEC)

Pronounced: NECK-ro-tize-ing ENT-ero-co-LYE-tis

En Español (Spanish Version)

Definition

Necrotizing enterocolitis (NEC) is a gastrointestinal disease that is found primarily in premature infants, although it can occur in full-term infants as well. An infection or inflammation causes the destruction of all or part of the bowel (small intestine) of the baby. This is a serious condition that requires care from your baby’s doctor. Almost all babies at risk for NEC are already hospitalized in a Neonatal Intensive Care Unit (NICU) and under close observation due to their small size.

Necrotizing Enterocolitis

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Causes

No exact cause is known for NEC. The bowel and intestine of a premature baby is not fully developed, and may not be able to handle the stress of food moving through them. A decrease in oxygen or blood flow to the intestines may cause damage, allowing bacteria to enter through the wall , leading to infection and inflammation. This can damage the strength of the intestinal tissue. If the bacteria remain long enough, they can make a hole in the wall of the intestine.

  • NEC is most often found in premature, very low-birthweight babies.
  • NEC usually occurs in the first two weeks of life, but can occur as late as three months of age.
  • NEC usually occurs soon after you have started feeding your baby.

Risk Factors

The risk of developing NEC is higher if your baby:

  • Was born before his or her due date
  • Is considered “high risk” and has started taking milk by mouth or feeding tube
  • Had a difficult delivery and had lowered oxygen levels during labor
  • Has a gastrointestinal infection
  • May be associated with use of indomethacin or early dexamethasone treatment

Symptoms

If your baby experiences any of these symptoms, do not assume it is due to NEC. The symptoms of NEC are very similar to other, less serious, digestive conditions. Every baby experiences the symptoms of NEC differently. The symptoms may include:

  • Difficulty feeding
  • Feedings stay in baby’s stomach longer than expected
  • A sudden increase in bowel movements, or lack of bowel movements
  • Bowel movements may be bloody
  • Baby doesn’t pass a lot of gas
  • Baby’s belly may be bloated, tender to the touch, or red
  • Vomit may be greenish in color
  • Baby shows general signs of infection, such as:
    • Stopping breathing or difficulty breathing
    • Low heart rate
    • Sluggishness
    • Vomiting
    • Temperature instability
    • Cool, clammy skin

Diagnosis

Your doctor will ask about your baby’s symptoms and medical history, and perform a physical exam. A gastroenterologist may work with your pediatrician to diagnose NEC.

Tests may include the following:

  • Lab tests—complete blood count, electrolytes, and blood culture may be performed.
  • Ultrasound of the abdomen—air in the large veins of the liver may show up better through ultrasound than on plain x-rays.
  • X-ray of the abdomen—doctors will be looking for bubbles in the intestine or signs of air in the large veins of the liver. Air may also be outside of the intestine in the abdomen.

Treatment

Most infants who get NEC have a complete recovery and don’t ever have feeding problems again. Treatment usually takes between 3 to 14 days. Talk with your doctor about the best treatment plan for your baby. Treatment options include combinations of the following:

Empty the Stomach

  • Stop feedings—Air or liquid in your baby’s stomach or intestine can make the condition worse. It will be necessary to stop feeding your baby.
  • A tube from the nose to the stomach (Nasogastric) will be placed to make sure your baby’s stomach and intestines remain empty, so that they can heal. The tube will remove air and fluid from the stomach.
  • IV (intravenous) fluids—the baby will get his or her nutrition and fluids through an IV, directly into the vein.

Antibiotics

Antibiotics are given to the baby to help heal the infection.

X-Rays

X-rays will be done frequently to watch the progress of the disease.

Oxygen

Baby may be given extra oxygen. If the infant’s stomach is very swollen, it can get in the way of his or her breathing. A machine called a ventilator may be used to help the baby breathe.

Protective Gowns and Gloves

Those caring for the baby may need to wear protective gowns and gloves to keep the infection from spreading.

In very severe cases of NEC, treatment may include:

Surgery

Surgery may be necessary to remove the diseased part of the intestine or bowel. Sometimes the healthy parts can then be sewn back together. If they can’t, part of the intestine or bowel may need to be rerouted to another area of the body where waste products can be removed.

Prevention

Since no one knows what the exact cause of NEC is, prevention is difficult.

  • Some studies have found that feeding your baby breast milk instead of formula may reduce the chance of NEC.
  • Doctors recommend starting feedings only after your baby is stable, and increasing the feeding amount very slowly.
  • Closely observe an infant for signs of feeding intolerance.
  • Probiotics may also decrease the incidence of NEC.

RESOURCES:

Kids Health
http://kidshealth.org/parent

North Carolina Public Health Nursing Continuing Education Advisory Committee
http://www.sph.unc.edu

CANADIAN RESOURCES:

Alberta Children's Services
http://www.child.gov.ab.ca

Sick Kids
The Hospital for Sick Children
http://www.sickkids.ca

References:

Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics . 17th ed. Philadelphia, PA: Saunders; 2004.

RM Kleigman, RE Behrman, HB Jenson, BF Stanton. Nelson Textbook of Pediatrics . 18th Edition. Eds. Saunders Publishers, Philadelphia PA, 2007.

Necrotizing enterocolitis. MedlinePlus Medical Encyclopedia, US National Library of Medicine and the National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm . Accessed September 27, 2005.

Necrotizing enterocolitis. The Merck Manual of Diagnosis and Therapy website. Available at http://www.merck.com/mrkshared/mmanual/section19/chapter260/260n.jsp . Accessed September 27, 2005.

Pietz J, Achanti B, Lilien L, Stepka E, Mehta S. Prevention of necrotizing enterocolitis in preterm infants: A 20-year experience. Pediatrics . 2007; 119:164-170.



Last reviewed January 2008 by Kari L. Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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