Necrotizing Enterocolitis (NEC) In Newborns: Symptoms, Causes And Treatment

Image: Shutterstock


Necrotizing enterocolitis (NEC) is a disease of intestines commonly seen in premature or extremely sick newborns. It is characterized by tissue inflammation of usually the large intestine. The inflammation may destroy the tissues of the baby’s large intestine (colon), making the condition potentially fatal.

The disease can occur in any newborn but is more common in premature infants weighing less than four pounds. It is rarely seen in older babies with normal body weight (1). Read this post to learn the causes, symptoms, treatment, and complications of NEC in babies.

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)
  • Blood in stools
  • Redness or any discoloration of the abdomen
  • Lethargy
  • 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).

  • Premature birth
  • Lower than normal birth weight
  • Gastrointestinal infections, especially in newborns
  • Other neonatal infections and illnesses
  • Formula feeding the newborn instead of breastfeeding (breast milk is rich in antibodies and immune cells)

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 seen 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
  • A needle might be inserted into the abdominal cavity to check intestinal fluid; the presence of fluid indicates perforation

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).

  • 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 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).

  • Scarring of the bowel
  • Intestinal blockage
  • 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

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).

  1. 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.

NEC is a potentially fatal illness, which is more common in premature babies. There is no way to prevent NEC. You can ensure adequate prenatal care to reduce the risk of premature childbirth. Full-term babies seldom show the problem but may develop it if they were extremely sick at birth. Stay alert to any signs and symptoms, such as poor feeding, and consult a doctor soon to initiate treatment early.


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
The following two tabs change content below.

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. Dr. Shah's deep interest in the well-being of babies and children... more