Definition

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.

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 perforate the intestine.

Risk Factors

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 labor
• Gastrointestinal infection
• Indomethacin or early dexamethasone treatment
• Being considered as high risk and has started taking milk by mouth or feeding tube

Symptoms

NEC may cause:

• Difficulty feeding
• Feedings stay in your 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
• Bloated abdomen that may be tender to the touch or red
• Vomiting, which may be greenish in color

General signs of infection include:

• Stopping breathing or difficulty breathing
• Low heart rate
• Sluggishness
• Vomiting
• Temperature instability
• Cool, clammy skin

Diagnosis

You will be asked about your baby’s symptoms and medical history. A physical exam will be done. Your baby’s doctor will work with a specialist to diagnose NEC.

Your baby’s bodily fluids will be tested. This can be done with:

• Blood tests
• Blood culture

Images may be taken of your baby’s bodily structures. This can be done with:

• Abdominal ultrasound
• Abdominal x-ray

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:

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 slowly.
• Closely observe your baby for signs of feeding intolerance.
• Probiotics may help decrease the risk of NEC.

National Institute of Child Health and Human Development http://www.nichd.nih.gov

Public Health Agency of Canada http://www.phac-aspc.gc.ca

Necrotizing enterocolitis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated August 25, 2015. Accessed September 15, 2015.

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.