Necrotizing Enterocolitis: Symptoms, Diagnosis And Treatment

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Necrotizing enterocolitis (NEC) commonly affects the intestines of premature or extremely sick newborns. The condition leads to inflammation in the baby’s large intestine (colon), which may eventually destroy their tissues, making the disease potentially fatal.

The disease may develop in any newborn; however, premature babies weighing less than four pounds are at a higher risk. The condition is rarely seen in older babies with normal body weight (1).

Read this post to learn about the causes of NEC in babies, its symptoms, treatment, and complications.

Signs And Symptoms Of NEC In Babies

Each baby may show different symptoms of NEC, depending on its severity and the overall health of the infant. The symptoms usually begin within two weeks after birth. The symptoms of NEC could include the following (1)(2)(3)(4).

  • Poor feeding or feeding intolerance
  • Abdominal distention (bloating or swelling of the belly)
  • Vomiting bile (green color vomit)
  • Diarrhea
  • Blood in stools
  • Redness or any discoloration of the abdomen
  • Lethargy
  • Fever
  • Apnea (pause in breathing)
  • Slow heart rate
  • Low blood pressure

Causes Of NEC In Babies

The exact causes of NEC are not known. The following factors may put an infant at a higher risk of developing NEC (1)(3)(5).

  • Lower than normal birth weight
  • Gastrointestinal infections, especially in newborns
  • Other neonatal infections and illnesses

How Common Is NEC In Babies?

NEC affects one out of 2,000 to 4,000 babies, and infants with NEC constitute one to five percent of babies admitted in the neonatal intensive care unit (NICU). About ten percent of premature infants experience NEC, but it is rare in full-term infants (3).

Diagnosis Of NEC In Babies

The doctor will check for symptoms and consider the risk factors, such as whether the baby was born premature, extremely sick, or with low birth weight. The diagnosis of NEC is confirmed by an X-ray that shows the presence of gas or air bubbles in the intestinal walls (2)(3).

Air bubbles may also be in veins supplying the liver, or air may be seen in the abdominal cavity. The presence of air bubbles indicates perforation of the intestines and other affected organs due to tissue damage.

The doctor may conduct the following tests to assess the baby further and determine the extent of NEC (5).

  • Blood tests to monitor electrolytes and blood gases
  • Stool examination to check for the presence of occult blood

Treatment For NEC In Babies

The treatment plan of NEC in babies depends on their general health, age, and severity of symptoms. The objective of the treatment is to subdue inflammation, contain any infection, and restore normal function of the intestines.

Several treatment procedures are simultaneously used for optimum results. The doctor may consider a combination of any of the following procedures (1).

  • Patient is kept on an NPO (Nothing by mouth)
  • Parenteral nutrition (intravenous nutrition)
  • Intravenous antibiotics
  • Draining of infected abdominal fluids
  • Surgical removal of the affected section of the intestine
  • Ostomy procedure connecting intestine to an opening in the abdomen to collect stool in an external bag

The baby may receive medications and mechanical ventilation (oxygen support) through the course of treatment. The duration of the treatment may vary for days to weeks, depending on several factors, such as stage of the disease and the baby’s response to treatment. Since NEC mostly occurs in premature babies, they may need to stay in the NICU for an extended period for observation.

Possible Complications And Prognosis Of NEC In Babies

Most infants with NEC recover fully after treatment and do not have any residual problems. However, the following complications may arise in some cases, causing long-term issues, such as feeding problems(3)(5).

  • Adhesions of the bowel
  • Intestinal stricture (narrowing of the intestines)
  • Severe intestinal perforation
  • Malabsorption of nutrients
  • Peritonitis (inflammation of the lining of the abdominal cavity)
  • Liver problems
  • Short bowel syndrome due to destruction of a section of the intestine
  • Failure to thrive
  • Neuro developmental delay
  • Sepsis

NEC could have a good prognosis when detected early. Babies who respond well to treatment and those with a few to no comorbidities may show a better prognosis. Almost 8 out 10 babies survive NEC (5).

Frequently Asked Questions

1. Why are premature babies at a higher risk of developing NEC?

Premature babies have premature lungs, which may not provide adequate oxygen to the body’s organs. Inadequate oxygen supply to the intestines could damage intestinal tissue, causing inflammation and increasing the risk of infection and perforation (1) (3).

2. Does NEC come back?

Recurrence of NEC is rare and usually occurs in 4-6% of cases (6). The risk of recurrence may be higher in premature infants with other problems or those with severe symptoms.

3. What are the types of necrotizing enterocolitis?

Based on the cause and symptoms, necrotizing enterocolitis (NEC) is often categorized into the following types (2):

  • Classic – Most common NEC type that usually affects infants born before 28 weeks of pregnancy.
  • Transfusion-associated – In this type, an infant may need a blood transfusion to treat anemia.
  • Atypical – When a baby develops NEC in the first week of life or before their first feed.
  • Term infant – It is an NEC type that develops in full-term infants. Full-term babies who get NEC usually have a congenital disability.

4. How can I prevent necrotizing enterocolitis?

There is no specific cause for NEC. Therefore, there is no definitive way of preventing the condition (7). Nevertheless, certain practices might reduce the risk, including exclusive breastfeeding, administering probiotics, and maternal corticosteroid injections during pregnancy. Except for breastfeeding, the remaining interventions must be under medical supervision (2).

Although the exact cause of NEC is yet to be known, premature birth, neonatal infections, and low birth weight are contributing factors. Treatment procedures such as intravenous antibiotics and draining the infected abdominal fluids can help manage the symptoms of this condition while providing some relief. In addition, it has been suggested that taking proper prenatal care and reducing the chances of premature childbirth can help in decreasing the incidence of NEC. If you notice any cautionary signs in your child, consult your doctor immediately.

Key Pointers

  • Bile vomiting, poor feeding, distended abdomen, fever, apnea, and lethargy are common signs of necrotizing enterocolitis in babies.
  • Gastrointestinal infections, low birth weight, premature birth, and neonatal infections can cause necrotizing enterocolitis in infants.
  • It is treated depending on the severity, and babies may receive parenteral nutrition, IV antibiotics, draining of accumulated fluid, and removal of the affected part from the intestines.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Necrotizing Enterocolitis in the Newborn; Stanford Children’s Health
2. Necrotizing Enterocolitis; Cleveland Clinic
3. Necrotizing Enterocolitis; Children’s Hospital Los Angeles
4. Necrotizing Enterocolitis (NEC); Children’s Hospital of Pittsburgh5. Necrotizing enterocolitis; U.S. National Library of Medicine
6. Cynthia D. Downardet al. Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review; Elsevier Journal of Pediatric Surgery
7. Necrotizing Enterocolitis in the Newborn; Stanford Children’s Health
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Dr. Ritika Shah

Dr. Ritika Shah is a certified lactation counsellor from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate... more

Dr. Ashraf Kasem

(MS)
Dr. Ashraf Kasem is a pediatric specialist with more than 10 years' experience in pediatrics, neonatology and pediatric nutrition. Having a pediatrics practice in Mansoura, Egypt, he is an influencer in Egypt and Arabic countries with more than 500,000 followers on his Facebook page. Dr. Kasem graduated from Mansoura University and did his masters degree in Pediatrics from Al Azhar... more

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