Necrotizing enterocolitis

Overview

Necrotizing enterocolitis, or NEC, is a serious disorder affecting a baby's gastrointestinal tract, which consists of the mouth, stomach, small intestine, large intestine and anus. Although the exact cause of NEC is unknown, it may be associated with an infection.

Damage caused by NEC to the intestines may create a hole in the intestines, allowing bacteria normally present in the intestines to leak out into the abdomen and cause infection. Even with treatment, this can cause serious complications. In more severe cases, it may be necessary to surgically remove part of the intestine. In the most severe cases, NEC can be fatal.

The vast majority of NEC cases are found in very premature infants. Even so, the condition only affects a small percentage of premature infants. Although NEC is rare, because of their increased risk premature infants are monitored closely during feedings.

Signs & symptoms

Symptoms of necrotizing enterocolitis may include:

• Abdominal distension or swelling in almost all cases (although most infants with abdominal distension don't have NEC)
• Signs of infection such as sluggishness and apnea, a condition in which the baby doesn't breathe properly
• An unstable temperature
• Bloody stools
• Poor feeding
• Feeding intolerance
• Bile-colored, or green, gastric residuals or vomiting

Diagnosis

If the doctor suspects that your baby has necrotizing enterocolitis, an abdominal X-ray will be taken to look for signs of the condition.

Treatment

Treatment of necrotizing enterocolitis depends on the severity of the baby's condition. The treatment plan may include medical treatments or surgery.

Medical Treatment

Medical treatments may include:

• Stopping all regular feedings and using an intravenous (IV) catheter to provide nutrients to the baby
• Placing a nasogastric tube extending from the baby's nose into the stomach to suction air and fluids from the baby's stomach and intestine
• Antibiotic therapy to treat possible infections
• Checking stools for blood
• Frequent blood tests to look for signs of infection and imbalances in the body's chemistry
• Oxygen or mechanically assisted breathing if abdominal swelling interferes with breathing
• In severe cases, platelet and red blood cell transfusion

Surgical Treatment

If a baby doesn't respond to medical treatment, or if there's a hole in the intestines, surgery is necessary. The pediatric surgeon will perform an abdominal laparotomy, a procedure that involves opening the abdomen to examine the condition of the bowel. With severe NEC, part of the bowel may be removed. The goal is to remove only the part of the bowel that has no chance of recovery. In some cases, a rubber tube is placed in the abdomen to allow drainage of infected fluid.

A temporary ostomy, in which an opening is made in the wall of the abdomen, may be necessary to allow the bowel to recover and heal. As part of the procedure, a stoma is created to allow the passage of stool. Another operation to reexamine the abdomen may be required 24 to 48 hours later to determine if NEC has progressed.