Necrotizing colitis is a serious gastrointestinal condition that primarily affects premature infants. It involves inflammation and injury to the intestinal tissue, which can progress to tissue death, known as necrosis. This condition typically develops within the first two to six weeks after birth in infants who are often already in a neonatal intensive care unit (NICU). The inflammation can damage the intestinal wall, potentially leading to a perforation, or hole, which allows bacteria to leak into the abdomen or bloodstream.
Causes and Primary Risk Factors
The precise cause of necrotizing colitis remains under investigation but is understood to result from a combination of factors, with the most significant risk factor being prematurity. An infant born prematurely has an underdeveloped intestinal system and an immature immune response, making them uniquely susceptible. Their bodies may struggle to circulate blood and oxygen efficiently, which can diminish blood flow to the intestinal tissues.
Infants fed with formula are at a higher risk compared to those who receive breast milk, which offers protective qualities. A difficult birth or any event that reduces oxygen levels can also contribute to the development of the condition. Infants with existing health issues, such as congenital heart defects that impact blood flow or those fighting other infections, face an increased risk of developing this intestinal disease.
Symptoms and Diagnosis
The signs of necrotizing colitis can develop over a few days or appear suddenly. One of the most common indicators is abdominal swelling, or distension, which makes the baby’s belly appear bloated and may be tender to the touch. Another frequent symptom is feeding intolerance; the infant may vomit, often green or yellow fluid, or have significant amounts of undigested milk remaining in their stomach before the next feeding. The appearance of blood in the stool is also a characteristic sign.
Beyond these digestive symptoms, an infant with this condition might show systemic signs of illness. These can include lethargy, an unstable body temperature, and changes in vital signs such as a slowed heart rate (bradycardia) or periods of stopped breathing (apnea).
To confirm a diagnosis, an abdominal X-ray is a primary method used to visualize the intestines. Doctors look for specific signs, such as air that has seeped into the intestinal wall (pneumatosis intestinalis). Another finding is free air in the abdominal cavity (pneumoperitoneum), which indicates the bowel has perforated.
In conjunction with imaging, blood tests are performed to check for markers of infection and inflammation, such as an elevated white blood cell count. These tests also help assess the baby’s overall metabolic state and can show signs of sepsis, a widespread infection.
Treatment Approaches
Once necrotizing colitis is diagnosed, treatment begins immediately. The initial approach is medical management designed to allow the bowel to rest and heal. This involves stopping all oral and tube feedings and placing a nasogastric (NG) tube through the nose into the stomach. This tube removes air and secretions to prevent the buildup of gas and fluid.
To ensure the infant receives nutrition and hydration while the bowel rests, intravenous (IV) fluids and nutrition are provided. This method, called total parenteral nutrition (TPN), delivers all necessary nutrients directly into the bloodstream. A course of broad-spectrum antibiotics is also administered intravenously to fight existing infection and prevent it from spreading.
Surgery is reserved for more severe cases, particularly when an abdominal X-ray confirms a hole in the intestine or if the infant’s condition worsens despite medical treatment. After removing the damaged section, the surgeon may be able to reconnect the healthy ends of the bowel. In some instances, it is necessary to create a temporary opening in the abdomen, called an ostomy, to allow the intestine to heal before it is reconnected in a later surgery.
Long-Term Outlook
The long-term prognosis for an infant with necrotizing colitis varies depending on the severity of the illness and the treatment required. Many infants treated successfully with medical management alone recover fully with no lasting complications. Their intestinal function returns to normal, and they can resume regular feedings once the inflammation has resolved.
For infants who require surgery to remove a portion of their intestine, the long-term outlook can be more complex. One potential complication is short bowel syndrome, where the remaining intestine is not long enough to absorb sufficient nutrients, which may require ongoing nutritional support. Another issue that can arise is the development of intestinal strictures, which are narrowed segments of the bowel that can cause blockages months after the initial illness.
Some studies have also noted an association between severe cases of this condition, especially those requiring surgery, and a risk of developmental delays. With diligent follow-up care and monitoring from a dedicated medical team, many children who survive necrotizing colitis go on to lead healthy and full lives.