A health condition that causes the intestinal tissue to die is called necrotizing enterocolitis (NEC). Usually, premature babies are at higher risk of developing it. In general, NEC is a medical emergency, and without immediate treatment, the bacteria may leak through the hole, causing severe abdominal (belly) infections. Doctors may recommend IV (intravenous) feedings to relieve the symptoms and improve the outlook of the condition. They may also recommend surgery to remove the damaged part of the intestine.
In other words, NEC is a serious gastrointestinal problem that usually occurs in premature babies. While some babies experience mild symptoms, others may have severe and even life-threatening symptoms.
Generally, this is a common gastrointestinal condition that affects about 1 in 1,000 premature babies. The risk is even higher when the baby weighs less than 2 pounds. In rare cases, NEC may occur in full-term infants (about 1 in 10,000 babies).
Types of Necrotizing Enterocolitis
Healthcare professionals have divided NEC into several types based on when the symptoms begin and what causes this disorder. For example:
- Classic – It is the most common form of this condition, and it usually negatively affects infants born before 28 weeks of pregnancy. While the prognosis is usually good, the condition often appears suddenly without warning.
- Transfusion-associated – Sometimes, babies need blood transfusions to treat anemia (low red blood cell count). Approximately 1 in 3 premature babies develop NEC within 3-4 days of getting a blood transfusion.
- Atypical – In rare cases, newborns may develop NEC in the first week of life before the first feeding.
- Term infant – In such cases, the condition occurs in full-term babies. These babies often have a birth defect (such as congenital heart defects, gastroschisis, and others). Gastroschisis is a condition in which the intestines develop outside the body.
Rarely, NEC may occur in neonatal intensive care units (NICUs). In general, babies stay in an intensive care unit due to severe health conditions.
Symptoms
The symptoms usually occur within a few days after the diagnosis, or they may occur suddenly. In general, this is a common problem among babies in NICUs. Check some general symptoms of NEC below:
- Diarrhea (sometimes bloody stools)
- Lethargy
- Appetite changes
- Lack of weight gain
- Yellow or green vomit
- Belly (abdominal) pain and swelling
- Changes in breathing, body temperature, blood pressure, and heart rate
Immediately contact your healthcare professional if your child experiences any of the previous symptoms.
Causes
Experts do not know the exact cause of NEC, but premature infants have a weaker immune system compared to full-term babies. Normally, the immune system helps fight off infections. Moreover, babies also have a weaker digestive system, which makes them more prone to intestinal infections (especially in preterm babies). When an intestinal infection occurs, a weakened immune system cannot fight it. Another contributing factor may be oxygen-rich blood that reaches the intestines more difficult. Therefore, reduced blood flow can cause damage to the tissue of the intestines, which can allow the bacteria to enter the bloodstream.
Risk Factors
Premature babies are at higher risk of developing necrotizing enterocolitis. Generally, this condition affects babies:
- Who are born before 37 weeks of pregnancy (premature babies)
- Fed through a tube in the stomach (also known as enteral nutrition)
- Weight less than 5 ½ pounds at birth
What Happens if Necrotizing Enterocolitis is Left Untreated?
Once your child is diagnosed with NEC, and he/she do not get treatment, it may lead to the following complications. Check some of them below:
- Intestinal stricture or perforation
- Sepsis
- Peritonitis
- Short bowel syndrome
- Liver problems (these issues are caused by prolonged inability to tolerate enteral feeds)
The previous list does not contain a full list of complications that babies with NEC can experience. In any case, you can consult with your healthcare provider about ways to reduce the risk or even avoid them.
How to Prevent Necrotizing Enterocolitis?
If your baby is at risk of preterm birth, doctors may recommend Corticosteroid injections to boost the health of the developing fetus. It also helps reduce the risk of developing lung and intestinal conditions. In addition, feeding your baby with breast milk may also reduce the risk of NEC. According to some research, adding probiotics to breastmilk or formula may also help.
Diagnosis
The diagnosis of NEC often begins with a physical examination to check for irregularities linked to the disease. Physicians may also ask some questions about the symptoms and family history to get more clues about the disease. Furthermore, physicians may also perform the following tests to confirm or rule out NEC. Examples include:
- X-rays – This is an imaging test used to get detailed images of the abdominal area. It may show air bubbles (gas), which often indicate a damaged bowel or perforation.
- Fecal test – It is used to check for blood in the stool.
- Blood tests – These tests are often done to check for bacteria and other signs of infection.
Treatment
Most babies with NEC need time to rest and heal. The primary treatments include stop tube or oral feedings and intravenous (IV) fluids and nutrients. Moreover, doctors may also prescribe the following treatments. For example:
- Nasogastric tube – This is a long and thin tube that is inserted through the nose (or sometimes the mouth) into the stomach to suction out gas and fluids.
- Antibiotics – This group of medications is used to treat bacterial infections.
Approximately 25% of babies with NEC need surgery to remove the damaged part of the intestine. This surgery is called an ostomy procedure, and it involves the following steps. For example:
- A small hole (stoma) in the child’s abdomen
- Connecting the large intestines to the stoma
- A bag outside the body that collects poop
When your child becomes stronger, surgeons may reconnect the intestines and replace them in the abdominal area. When surgery is not an option, doctors may use a catheter to drain unhealthy fluids and gas. It also helps relieve the symptoms.
Frequently Asked Questions
What is the prognosis for people who have necrotizing enterocolitis?
Approximately 80% of babies with NEC survive, but may develop chronic health problems that require regular treatment. For more details, discuss it with your physician.
What are the intestines?
The intestines (including small and large) are a part of the digestive system that turn food into liquids and waste. Therefore, the body removes the waste products through poop.
What are the symptoms of NEC?
These include:
- Bloody stools
- Abdominal distention (swelling)
- Gastric drainage or green vomit
- Poor feeding
- Difficulty with weight gain
- Lethargy (sluggishness)
Immediately contact your doctor if any of the previous symptoms occur. Ask your healthcare provider if you have any other questions.
