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Necrotizing Enterocolitis

Definition

Necrotizing enterocolitis (NEC) is a serious condition of the intestine. The intestine digests food. It also moves food from the stomach to the anus. NEC is the swelling and destruction of a part of the intestine. This condition often occurs soon after your baby starts feeding. It is found mostly in premature and very low birthweight babies. NEC can also be found in full-term infants.

This is condition requires care from your baby’s doctor. NEC often occurs in the first two weeks of life but can occur as late as 3 months of age. The baby is often still in the hospital when NEC starts.

Necrotizing Enterocolitis
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Causes

The exact cause of NEC is not known. Below is a possible series of events that can lead to NEC:

  • Premature babies do not have fully developed intestines. This may make it difficult for the intestines to handle the stress of moving food.
  • The stress may cause a decrease in oxygen or blood flow to the intestines. The loss of oxygen and blood flow can cause damage to the intestine.
  • Bacteria can enter the intestine through the damaged area. The bacteria can lead to an infection and swelling. This will weaken the wall of the intestine even further.
  • If the process continues it can make a hole in the intestine.

Risk Factors

The risk of developing NEC is higher if your baby:

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

Symptoms

If your baby has any of these symptoms, do not assume it is due to NEC. The symptoms may be caused by other, less serious conditions. Symptoms will vary by child but may include:

  • Difficulty feeding
  • Feedings stay in baby’s stomach longer than expected
  • A sudden increase in bowel movements, or lack of bowel movements
  • Bloody bowel movements
  • Baby doesn’t pass a lot of gas
  • Belly may be bloated, tender to the touch, or red
  • Vomit—may be greenish in color
  • 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. A physical exam will be done. Your pediatrician will work with a specialist to diagnose NEC.

Tests may include the following

  • Lab tests—complete blood count, electrolytes, and blood culture may be done. This will be done to look for infections.
  • Ultrasound of the abdomen—ultrasound can create images with certain details that are difficult to catch on a standard x-ray
  • X-ray of the abdomen—images of the entire abdomen which may show a leak in the intestine
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Treatment

Most babies who get NEC have a complete recovery. 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

Air or liquid in your baby’s intestine can make the condition worse. You will be asked to stop feeding your baby. A tube will be placed through the baby's nose into the stomach. This tube will remove liquid and air from your baby’s stomach. Removing these will help the intestine heal.

Nutrition and fluids will be given to your baby through an IV. An IV can deliver nutrition directly into your child's blood stream.

Antibiotics

Antibiotics are used to fight infections caused by bacteria. Your baby may be given antibiotic to stop the current infection or prevent a new one.

X-Rays

X-rays will be done often. They will help your doctor see the progress of the NEC.

Oxygen

NEC can cause swelling in the stomach. This may make it difficult for the baby to breathe. Oxygen may be given to improve the baby's oxygen levels. A machine called a ventilator may be used. It will help or take over breathing for the baby.

Infection Prevention

Some infections can pass easily through touch or near contact. Certain steps can keep these infections from spreading. You and your baby's caretakers may wear gowns and gloves to protect your baby and others. Regular handwashing is also important in any infection prevention.

Surgery

For some, the damage to the intestine may be severe. In this case, surgery may be needed.

Surgery is done to remove the damaged part of the intestine. The healthy parts are sewn back together when possible. Sometimes there is too much damage to be able to sew the intestine back together. In this case, part of the intestine will be connected to an opening in the abdomen wall. The opening will allow waste products to pass to a bag outside the body.

Prevention

Prevention is difficult since the exact cause of NEC is unknown. Some steps that may be helpful include:

  • Breastmilk may reduce the chance of NEC compared to formula
  • The first feeding may be postponed until your baby is stable. Increase the feeding amount very slowly.
  • Closely observe your baby for signs of feeding intolerance.
  • Probiotics may help decrease the risk of NEC.

Resources

American Academy of Pediatrics
http://www.healthychildren.org/
National Institute of Health & Human Development
http://www.nichd.nih.gov/

Canadian Resources

Maternal and Infant Health
Public Health Agency of Canadahttp://www.phac-aspc.gc.ca/

References

DynaMed Editorial Team. Necrotizing enterocolitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 10, 2012. Accessed July 25, 2012.
Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for necrotizing enterocolitis (NEC) among very low birth weight infants. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2010 Oct 7. Accessed July 25, 2012.
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.