Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition that primarily affects premature or sick newborns, causing inflammation and damage to the intestinal tissue. This inflammation can lead to the death of sections of the bowel, and in severe cases, a hole (perforation) may form in the intestinal wall. When a perforation occurs, bacteria can leak from the intestine into the abdominal cavity or bloodstream, potentially causing life-threatening infection. NEC usually develops within two to six weeks after birth, with symptoms ranging from mild to severe.
Recognizing Necrotizing Enterocolitis
Parents and caregivers may observe signs of necrotizing enterocolitis in an infant. Common symptoms include abdominal swelling and tenderness, which may be accompanied by discoloration of the skin over the abdomen, appearing red, blue, or gray. Feeding intolerance is also a common symptom, including vomiting, green or yellow bile-colored vomit, or a refusal to feed. Other signs can include bloody stools, diarrhea, constipation, decreased activity, lethargy, and changes in the baby’s body temperature, heart rate, or breathing patterns.
Healthcare professionals diagnose NEC through physical examination, imaging, and blood tests. During a physical exam, a doctor may detect abdominal swelling, tenderness, or a mass, which could indicate a perforation. Abdominal X-rays are a common diagnostic tool, revealing abnormal gas patterns such as small air bubbles or streaky gas within the intestinal wall (pneumatosis intestinalis). In more severe cases, X-rays may show free air in the abdominal cavity or gas in the large veins of the liver, indicating a bowel perforation. Blood tests help identify signs of infection or inflammation, and may also check for anemia or low platelet counts.
Understanding Risk Factors
Factors increasing a newborn’s susceptibility to necrotizing enterocolitis include prematurity. This is the most significant risk; the younger and smaller a baby is at birth, the higher their likelihood of developing NEC. Over 90% of NEC cases occur in preterm infants, particularly those weighing less than 3 pounds, 5 ounces (1,500 grams). Their underdeveloped immune and digestive systems are less equipped to handle infections and provide a protective barrier against bacteria in the intestines.
Conditions that reduce blood flow to the intestines also elevate the risk. These can include congenital heart disease, severe illness at birth, birth asphyxia (lack of oxygen), or low blood pressure. Such issues can compromise the intestinal tissue, making it more vulnerable to damage and bacterial invasion. Formula feeding is also a risk factor compared to breast milk, which contains protective factors that may inhibit the growth of harmful bacteria and strengthen intestinal cells.
Treatment Approaches
Treating necrotizing enterocolitis involves medical management and, at times, surgical intervention. Initial medical treatment aims to rest the bowel and fight infection. This includes stopping all oral feedings, providing nutrition and fluids intravenously, and inserting a nasogastric tube to suction out air and fluids, alleviating swelling and discomfort. Broad-spectrum antibiotics are administered to combat bacterial infection, usually for 10 to 14 days. The baby’s condition is closely monitored through frequent X-rays and blood tests to track disease progression and check for signs of infection or electrolyte imbalances.
Surgical intervention becomes necessary if medical treatment fails, if there’s evidence of a bowel perforation, or if the disease progresses to severe stages. The most common surgical approach is a laparotomy, where damaged sections of the intestine are removed, preserving as much healthy bowel as possible. Often, a temporary ostomy is created, an opening in the abdominal wall to allow the bowel to heal and divert waste. A drain may also be placed in the abdomen to remove infected fluid.
Preventing Necrotizing Enterocolitis
Prevention of necrotizing enterocolitis focuses on protecting vulnerable infants. Feeding premature infants with breast milk or donor human milk is a primary preventive measure, as human milk provides antibodies, growth factors, and immune cells that support gut health and offer protection against NEC. The careful and gradual introduction of feedings also helps prevent overwhelming an immature digestive system.
The use of probiotics is a promising area for NEC prevention. Probiotic supplementation can reduce the risk of NEC by modulating the intestinal microbiome. Combinations of bacteria such as Bacillus and Lactobacillus species, or Bifidobacterium and Streptococcus species, have shown effectiveness. Additionally, maintaining strict infection control measures in neonatal intensive care units (NICUs) minimizes the spread of bacteria that could contribute to NEC.