Infant necrotizing enterocolitis (NEC) is a serious gastrointestinal condition that primarily affects premature infants. This inflammatory disease of the intestine can lead to severe damage and, in some cases, the death of intestinal tissue. Understanding NEC is important for parents and caregivers because of its sudden onset and rapid progression.
Understanding Necrotizing Enterocolitis
Necrotizing enterocolitis is a condition where inflammation and bacterial invasion occur within the intestinal wall, leading to tissue death. It is a serious emergency affecting infants, particularly those in neonatal intensive care units. While the exact cause is not fully understood, it is believed to involve a combination of poor blood flow to the intestines and infection.
The condition predominantly affects premature infants, especially those born before 37 weeks of gestation or with low birth weight. Roughly 70% of NEC cases occur in infants born before 36 weeks gestation, affecting 2% to 5% of all premature infants. Their immature digestive and immune systems make them more susceptible due to underdeveloped intestinal lining and challenges with circulation or digestion. While less common, full-term infants can also develop NEC, often in the first few days of life, typically associated with other major medical issues like congenital heart disease or sepsis.
Recognizing the Signs and Diagnosis
Parents and caregivers should observe specific symptoms to identify necrotizing enterocolitis in an infant. These include abdominal swelling, tenderness, or a red, blue, or gray discoloration of the abdomen. Feeding difficulties, such as poor feeding or food staying in the stomach longer than expected, are common, along with green or yellow vomit containing bile. Other signs include bloody stools, lethargy, unstable body temperature, pauses in breathing (apnea), or a slowed heart rate (bradycardia).
Early recognition of these signs is important due to the condition’s potential for rapid progression. When NEC is suspected, medical professionals use various diagnostic methods. A physical examination may reveal abdominal swelling, tenderness, a palpable mass, or redness of the abdominal wall.
The primary diagnostic tool is an abdominal X-ray, which can show characteristic findings like multiple small bubbles or streaks of gas in the intestinal wall (pneumatosis intestinalis). In more severe cases, the X-ray might reveal air in the large veins of the liver or free air in the abdominal cavity, indicating a perforation. Blood tests, such as a complete blood count, are also performed to check for infection, anemia, or low platelet count, and blood cultures can identify bacterial infections.
Treatment Approaches
Treating necrotizing enterocolitis begins with non-surgical medical management if the intestine is not perforated or only a small area is affected. This initial approach involves stopping all oral feedings to allow the intestines to rest and heal. Instead, the infant receives nutrients and fluids intravenously through a catheter.
A nasogastric tube is inserted through the nose into the stomach to suction out air and fluids, which helps relieve swelling and discomfort. Broad-spectrum antibiotics are administered intravenously to combat bacterial infection. The infant’s condition is closely monitored, including frequent checks for blood in stools and regular blood tests to detect early signs of infection or imbalances in body chemistry.
If the infant’s condition worsens, if there is evidence of bowel perforation, or if medical therapy is not effective, surgical intervention becomes necessary. During surgery, a pediatric surgeon will carefully examine the intestine and remove only the damaged or dead sections, aiming to preserve as much healthy bowel as possible. If rejoining the healthy ends of the intestine is not immediately possible, a temporary ostomy may be created, where a part of the bowel is brought out onto the skin of the baby’s abdomen, allowing waste to collect in an external bag. A second operation may be needed later to reconnect the intestines once the infant has recovered.
Prevention and Long-Term Outlook
Reducing the risk of necrotizing enterocolitis involves several strategies, though complete prevention is not always possible. One of the most effective preventive measures for premature infants is feeding them breast milk, which has been shown to lower the incidence of NEC compared to formula feeding. Careful feeding practices, including a gradual introduction of enteral feeds, are also considered. The use of probiotics, which introduce beneficial bacteria, may also help reduce the risk.
For infants who survive NEC, the general outlook varies depending on the severity of the condition and whether surgery was required. Many infants who experience milder forms of NEC and respond to medical treatment recover fully without lasting feeding problems. However, some infants may face long-term complications.
These can include intestinal strictures, where scarring within the intestine causes narrowing, potentially leading to discomfort or bowel obstruction requiring further surgery. If a significant portion of the intestine is removed during surgery, infants may develop short bowel syndrome, which impairs nutrient absorption and may necessitate prolonged intravenous nutrition. Other potential long-term issues include growth failure and neurodevelopmental delays, particularly in infants who underwent surgery. Ongoing follow-up care is needed for affected infants to monitor their growth, development, and address any emerging complications.