Necrotizing enterocolitis (NEC)

Passing the time while your baby is in the NICUNecrotizing enterocoloitis, also known as NEC, is a condition of the intestinal tract that almost only affects premature babies. It often begins 2 or 3 weeks after birth and appears in preemies who seem to be getting better. NEC occurs when the lining of the intestine becomes inflamed. Most of the time, the damaged section of the intestine will heal on its own. But in some cases, the tissue dies. When this happens, that part of the intestine no longer works the way that it should. This damage may cause the intestine to tear. The bacteria in the intestine can then enter the blood and this can then lead to infection throughout the body.

What causes NEC?

Researchers are still not exactly sure what causes NEC. But in premature infants, it is probably related to the immaturity of the baby’s intestine. Some other factors that may contribute to NEC include:

  • An injury to the immature intestine
  • Reduced blood flow to the intestine
  • Growth of bacteria in the intestine that damages the intestinal wall

What are the signs of NEC?

NEC can be difficult to diagnose. The early signs can be similar to other infections or to problems caused by feeding difficulties often seen in preemies. However, NEC can get worse very quickly. Some common symptoms include:

  • Loss of appetite, not tolerating feedings
  • Red, painful, and swollen belly
  • Diarrhea or bloody stool
  • Decreased activity
  • Body temperature instability (may be lower than normal or fluctuate)
  • Episodes of low heart rate or apnea
  • Sometimes greenish vomit

Doctors can diagnose NEC with an X-ray of the belly.  When they examine the X-ray, they are looking for tiny gas bubbles inside the walls of the intestine. They can also see if air has leaked out of the intestine through a tear or hole.

How is NEC treated?

Early diagnosis and intervention is very important. Typical treatment includes:

  • Stopping oral (mouth) feedings and replacing with IV nutrition to give the bowel time to rest,
  • Inserting a tube through the nose and into the stomach to remove air and other secretions from the intestine,
  • Giving broad-spectrum antibiotics to treat and prevent infection,
  • Continuous monitoring using X-rays, blood and urine cultures,

If these interventions work, NEC typically lasts 2-3 weeks, although the critical stage is often over after a few days. Usually doctors will continue IV feedings until the intestines heal and the pockets of gas have been gone for 5 or more days. They will then start to gradually re-introduce oral feedings.

Surgery may be necessary for those babies who do not respond to the treatments above. In that case, the surgeon will remove the damaged section of intestines.

How can NEC be prevented?

Researchers are trying to better understand NEC so that they can prevent it. However, here are some things that seem to be beneficial:

  • It is important to start oral feedings early. The introduction of tiny amounts of milk to the digestive system may help the intestine to mature faster and possibly reduce the chance of your baby developing NEC.
  • Early feeding with colostrum and breast milk may be beneficial. It is easy to digest, supports the growth of good bacteria in the intestine, and helps to build your baby’s immune system.

If your baby has NEC or had it in the past, please go to Share Your Story where you can connect with other families and find comfort, support, and advice.

Have questions? Text or email us at AskUs@marchofdimes.org.

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