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Necrotizing enterocolitis (NEC) is a serious condition of the intestine. The intestine digests food. It also moves food from the stomach to the anus. NEC is the swelling and destruction of a part of the intestine. This condition often occurs soon after your baby starts feeding. It is found mostly in premature and very low birthweight babies. NEC can also be found in full-term infants.

This is condition requires care from your baby’s doctor. NEC often occurs in the first two weeks of life but can occur as late as 3 months of age. The baby is often still in the hospital when NEC starts.

Necrotizing Enterocolitis

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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 make a hole in the intestine.

The risk of developing NEC is higher if your baby:

• Was born before his or her due date
• Had a difficult delivery or low oxygen levels during labor
• Has a gastrointestinal infection
• Had indomethacin or early dexamethasone treatment
• Is considered “high risk” and has started taking milk by mouth or feeding tube

If your baby has any of these symptoms, do not assume it is due to NEC. The symptoms may be caused by other, less serious conditions. Symptoms will vary by child but may include:

• Difficulty feeding
• Feedings stay in 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
• Belly may be bloated, tender to the touch, or red
• Vomit—may be greenish in color
• General signs of infection, such as:
  • Stopping breathing or difficulty breathing
  • Low heart rate
  • Sluggishness
  • Vomiting
  • Temperature instability
  • Cool, clammy skin

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

Tests may include the following

• Lab tests—complete blood count, electrolytes, and blood culture may be done. This will be done to look for infections.
• Ultrasound of the abdomen—ultrasound can create images with certain details that are difficult to catch on a standard x-ray
• X-ray of the abdomen—images of the entire abdomen which may show a leak in the intestine

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