Necrotizing enterocolitis (NEC) is a serious intestinal illness in babies.
Although NEC may develop in low-risk newborns, 60-80% of cases occur in premature babies. NEC occurs in about 10% of babies weighing less than 1,500 grams (3 pounds, 5 ounces).
NEC involves damage to the intestinal tissues, which can lead to perforation (a hole) in the intestines. This allows the bacteria normally present in the intestinal tract to leak out into the abdomen and cause infection. The damage may only exist in a small area, or it may progress to large areas of the intestine. The disease can progress very quickly. Infection in the intestines can be overwhelming to a baby and, even with treatment, there may be serious complications.
Problems from NEC may include the following:
It is not clear exactly what causes NEC. It is thought that the intestinal tissues are somehow weakened by too little oxygen or blood flow. When feedings are started and the food moves into the weakened area of the intestinal tract, bacteria from the food can damage the intestinal tissues. The tissues may be severely damaged and die, which can cause a hole to develop in the intestine. This can lead to severe infection in the abdomen.
Premature babies have body systems that are more immature. As a result, they may have difficulty with blood and oxygen circulation, digestion and fighting infection, thus, increasing their chances of developing NEC.
Babies, especially premature babies, who are taking milk by mouth or tube feedings are at an increased risk for developing NEC. NEC is rare in babies who have not received feedings.
Babies who have had a difficult delivery or lowered oxygen levels are at an increased risk for developing NEC. When there is too little oxygen, the body sends the most blood and oxygen to essential organs and away from the intestinal tract. This can result in lowered oxygen in the gastrointestinal circulation.
Babies with too many red blood cells in the circulation are at an increased risk of developing NEC. This thickens the blood and makes oxygen transport more difficult.
Babies with gastrointestinal infections are at an increased risk of developing NEC.
The following are the most common signs of necrotizing enterocolitis. However, each child may experience symptoms differently. Symptoms usually develop in the first 2 weeks and may include the following:
The symptoms of necrotizing enterocolitis may resemble other digestive conditions or medical problems. Always consult your child's physician for a diagnosis.
NEC is diagnosed by examining the baby for the signs listed above. An x-ray of the abdomen may show a bubbly appearance in the intestine and signs of air or gas in the large veins of the liver. Air may also be outside the intestines in the abdomen. A needle may be inserted into the abdominal cavity. Withdrawing intestinal fluid from the abdomen is often a sign of a hole in the intestines.
Specific treatment for necrotizing enterocolitis will be determined by your baby's physician based on the following:
Treatment may include the following:
Severe cases of NEC may require:
Because the exact causes of NEC are unclear, prevention is often difficult. Studies have found that breast milk (rather than formula) may reduce the incidence of NEC. Also, starting feedings after a baby is stable and slowly increasing feeding amounts have been recommended.