Necrotizing Enterocolitis (NEC) in the Newborn

NEC is a serious health problem. It occurs when an area of the baby’s bowel (intestine) becomes damaged. This damage happens when a part of the intestines isn’t getting enough oxygen. This causes the tissue to die (become necrotic). Bacteria in the bowel may then start to kill tissue from the inner layers of the bowel, spreading out. NEC is more common in premature infants because the bowel is not yet mature.

Baby with head turned to side showing esophagus, stomach, liver, and intestines.
The normal digestive system

How is NEC diagnosed?

NEC may be the problem if the baby has trouble feeding, vomits, or has large residuals (food staying in the stomach). The baby may also have blood in the stool and a bloated abdomen. An X-ray can show thickening of the bowel wall. It may also show bubbles of gas in the bowel wall. NEC is an inflammation of the bowel that can be very serious. The exact cause of NEC is not known. But it happens more often in premature babies, especially those who have not gotten human milk. Human milk has many protective factors that formula can't provide. But even premature babies who haven't received formula can get NEC. The earlier the baby, the higher the risk.

What is a "NEC watch" or "NEC scare"?

Babies who are born premature or who have health problems are treated in the NICU (neonatal intensive care unit). NICU staff may suspect that a baby’s bowel may be damaged. This may be referred to as "NEC watch" or "NEC scare." In many cases, this can be prevented from turning into NEC. Breast milk or formula feedings are stopped. The baby is then given nutrition through a tube in a vein. This is called total parenteral nutrition (TPN). It allows the bowel to rest. The baby will most likely be given antibiotics to prevent infection. In many cases, there is no lasting damage to the bowel. No further treatment is needed.

How is NEC treated?

A baby with NEC will first be assessed to see if emergency surgery is needed. Treatment may consist of:

  • Medical treatment. Enteral feedings (feedings through the digestive tract) are stopped to rest the bowel. The baby is fed with TPN. Antibiotics are used to prevent infection and more damage. If the baby is very ill, or doesn’t start to get better within a couple of days, surgery may be the next step. In some cases, babies are treated with probiotics. These are live microorganisms that are put into the digestive tract.

  • Surgery to do any or all of the following, depending on the location and severity of the damage:

    • Place a drain into the abdomen to ease pressure and inflammation. This allows the bowel to rest and heal.

    • Take out part of the bowel. The necrotic or dead part of the bowel is taken out. This protects the rest of the bowel and lets it heal.

    • Place an enterostomy to let a part of the bowel heal by rerouting the stool. In this case, the surgeon will make an enterostomy (also called an ostomy or a stoma). This is done by bringing the open ends of the bowel through an incision in the abdomen. A stoma keeps waste from traveling through the part of the bowel that needs to rest. After the bowel has healed, the ends are then reconnected, and the ostomy is closed.

What are the long-term effects?

Many babies with NEC have no lasting damage. But NEC can cause serious ongoing problems. It can also be life threatening. If surgery is needed, the outcome depends on how much bowel is taken out. Sometimes the remaining bowel can take over the functions of the part of the bowel that was removed. In some cases, the baby can’t absorb certain nutrients and may need to be on a special diet. In other cases, the child may have a permanent stoma. But a child can thrive with a stoma, or even with much of the colon (large intestine) taken out. In rare cases, so much bowel is removed that the baby needs to stay on TPN for a long time. This can have other side effects such as infection or liver damage.

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