What is Necrotizing enterocolitis (NEC)?

Necrotizing enterocolitis (NEC) is an inflammation in the intestines (usually the colon) that can be life-threatening if not treated right away. NEC may affect only the lining of the intestine or its entire thickness. The damage caused by NEC to the intestinal tissues can cause a hole in the intestines that allows the bacteria normally present only in the intestinal tract to leak out into the abdomen and cause infection. Once this occurs, the infection can progress very quickly and is considered a medical emergency.

NEC most commonly affects premature babies, accounting for 60 to 80 percent of cases. It is the most common gastrointestinal emergency in the Neonatal Intensive Care Unit (NICU). It usually occurs within 3-12 days after birth.

What causes NEC?

The cause of NEC is unclear; it may be a result of too little oxygen or blood flow reaching the intestines, causing them to weaken. Once in this weakened state, bacteria from food that enters the intestines can cause damage or death to the tissues and lead to a severe infection. Contrary to popular belief, breast milk does not cause or prevent NEC. Prematurity is the most common cause.

What are the symptoms of NEC?

Symptoms of NEC usually develop in the first 2 weeks and may include the following:

  • Bloating or swelling in the tummy
  • Poor tolerance to feedings
  • Frequent vomiting (possibly green in color)
  • Bloody stool (bowel movements)
  • Redness or abnormal color to the tummy
  • Lethargy (lack of energy)
  • Fever
  • Apnea (pauses in breathing)

How is NEC diagnosed?

NEC is diagnosed by examining the baby for the symptoms listed above (usually swelling (distention) and tenderness. An X-ray of the abdomen may show a bubbly appearance in the intestine and signs of air or gas in the large veins of the liver. Air may also be outside the intestines in the abdomen. A needle may be inserted into the abdominal cavity to check for the presence of intestinal fluid (a sample is usually taken), which is often a sign of a hole in the intestines.

How is NEC treated?

Treatment of NEC is dependent on many things including the baby’s age and overall health, his/her tolerance for specific medications, and the extent of the disease.

Some of the steps taken for treating NEC may include:

  • Antibiotics to fight the infection
  • Checking bowel movements
  • Stopping regular feedings by mouth and instead being fed through an IV
  • Regular x-rays to monitor the progress of NEC
  • A tube placed in the stomach either through the nose or the mouth; the tube removes air and fluid from the baby's stomach and intestine
  • Regular blood work to monitor for infection
  • Possible breathing support (depends on severity)

In severe cases of NEC, surgery may be required to remove the diseased part of the intestine.

What is the prognosis for NEC?

Occasionally, problems, such as scarring or narrowing of the intestine (obstruction) or the inability for the intestine to absorb nutrients properly (malabsorption) occur.

Consult your baby's physician regarding the specific prognosis for your baby.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/7/2014...#10026