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Necrotizing enterocolitis

 

Necrotizing enterocolitis (NEC) is the death of tissue in the intestine. It occurs most often in premature or sick babies.

Causes

Necrotizing enterocolitis occurs when the lining of the intestinal wall dies. This problem nearly always develops in an infant who is ill or premature. It is likely to occur while the infant is still in the hospital.

The exact cause of this disorder is unknown. A drop in blood flow to the bowel can damage the tissue. Bacteria in the intestine may also add to the problem. Also, premature infants have an undeveloped immune response to factors such as bacteria or low blood flow. An imbalance in immune regulation appears to be involved in NEC.

Babies at higher risk for the condition include:

  • Premature infants
  • Infants who are fed formula rather than human milk. (Human milk contains growth factors, antibodies and immune cells which may help prevent the problem.)
  • Infants in a nursery where an outbreak has occurred
  • Infants who have received blood exchange transfusions or have been seriously ill

Symptoms

 

Symptoms may come on slowly or suddenly, and may include:

  • Abdominal bloating
  • Blood in the stool
  • Diarrhea
  • Feeding problems
  • Lack of energy
  • Unstable body temperature
  • Unstable breathing, heart rate, or blood pressure
  • Vomiting

 

Exams and Tests

 

Tests may include:

  • Abdominal x-ray
  • Stool for occult blood test (guaiac)
  • CBC (complete blood count)
  • Electrolyte levels, blood gases and other blood tests

 

Treatment

 

Treatment for a baby who may have necrotizing enterocolitis most often includes:

  • Halting enteral (GI tract) feedings
  • Relieving gas in the bowel by inserting a tube in the stomach
  • Giving IV fluids and nutrition
  • Giving IV antibiotics
  • Monitoring the condition with abdominal x-rays, blood tests, and measurement of blood gases

The infant will need surgery if there is a hole in the intestines or inflammation of the abdominal wall (peritonitis).

In this surgery, the doctor will:

  • Remove dead bowel tissue
  • Perform a colostomy or ileostomy

The bowel may be reconnected after several weeks or months when the infection has healed

 

Outlook (Prognosis)

 

Necrotizing enterocolitis is a serious disease. Up to 40% of infants with NEC die from it. Early, aggressive treatment can help improve the outcome.

 

Possible Complications

 

Complications may include:

  • Peritonitis
  • Sepsis
  • Intestinal perforation
  • Intestinal stricture
  • Liver problems from prolonged inability to tolerate enteral feeds and need for parenteral (IV) nutrition
  • Short bowel syndrome if a large amount of intestine is lost

 

When to Contact a Medical Professional

 

Get emergency medical care if any symptoms of necrotizing enterocolitis develop. Infants who are hospitalized for illness or prematurity are at higher risk of NEC. They are watched closely for this problem before they are sent home.

 

 

References

Caplan M. Necrotizing enterocolitis of the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap. 94.

 
  • Infant intestines

    Infant intestines - illustration

    The intestines are responsible for the majority of fluid absorption.

    Infant intestines

    illustration

    • Infant intestines

      Infant intestines - illustration

      The intestines are responsible for the majority of fluid absorption.

      Infant intestines

      illustration

    Tests for Necrotizing enterocolitis

     

       

      Review Date: 4/27/2015

      Reviewed By: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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