What is Necrotizing Enterocolitis?

Necrotizing enterocolitis, or NEC, is the death of intestinal tissue. Primarily affecting premature infants or sick newborns, it occurs when the lining of the intestinal wall dies and the tissue falls off. Although the cause for this disorder is unknown, it is thought that a decrease in blood flow to the bowel keeps the bowel from producing mucus that protects the gastrointestinal tract. Bacteria in the intestine may also be a cause. Those with a higher risk for this condition include:

• Premature infants

• Infants who are fed concentrated formulas

• Infants in a nursery where an outbreak has occurred

• Infants who have received blood exchange transfusions

Necrotizing Enterocolitis | David Hackam, M.D., Ph.D.

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Symptoms

• Abdominal distention

• Diarrhea

• Feeding intolerance

• Lethargy

• Temperature instability

• Vomiting

Diagnosis

• Abdominal X-ray

• Stool for occult blood test

• Elevated white blood cell count

• Low platelet count (thrombocytopenia)

• Lactic acidosis

Treatment

In an infant suspected of having necrotizing enterocolitis, feedings are stopped and gas is relieved from the bowel by inserting a small tube into the stomach. Intravenous fluid replaces formula or breast milk. Antibiotic therapy is started. The infant's condition is monitored with abdominal x-rays, blood tests, and blood gases.

Surgery will be needed if there is a hole in the intestines or peritonitis, an inflammation of the abdominal wall. The dead bowel tissue is removed and a colostomy or ileostomy is performed. The bowel is then reconnected several weeks or months later when the infection and inflammation have healed.

Prognosis

Necrotizing enterocolitis is a serious disease with a death rate approaching 25 percent. Early, aggressive treatment helps improve the outcome.