Necrotizing enterocolitis (NEC) is a serious condition of the intestine. The intestine digests food as it propels it through the digestive tract. NEC involves intestinal inflammation and tissue death. This condition often occurs soon after your baby starts feeding.
NEC can be a serious condition and requires immediate care. It often occurs in the first 2 weeks of life, but can occur as late as 3 months of age. The baby is often still in the hospital when NEC starts.
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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 perforate the intestine.
NEC is mostly found in premature and very low birthweight babies, but it can occur in full-term infants. Factors that may increase your baby's chance of NEC include: A difficult delivery or low oxygen levels during laborGastrointestinal infectionIndomethacin or early dexamethasone treatmentBeing considered as high risk and has started taking milk by mouth or feeding tube
NEC may cause: Difficulty feedingFeedings stay in your baby’s stomach longer than expectedA sudden increase in bowel movements, or lack of bowel movementsBloody bowel movementsBaby doesn’t pass a lot of gasBloated abdomen that may be tender to the touch or redVomiting, which may be greenish in color
General signs of infection include: Stopping breathing or difficulty breathingLow heart rateSluggishnessVomitingTemperature instabilityCool, clammy skin
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: Blood testsBlood cultureAbdominal ultrasoundAbdominal
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:
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. This helps 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 are used to fight infections caused by bacteria. Your baby may be given antibiotics if an infection is present or possible.
X-rays will be done often. They will help your doctor see the progress of the NEC.
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 ventilator may be used to help or take over breathing for the baby.
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.
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 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 formulaThe 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.
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.
Necrotizing enterocolitis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated June 2, 2014. Accessed August 21, 2014.
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 August 2014 by Kari 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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