Premature babies are at risk for necrotizing enterocolitis (NEC). The condition causes intestinal tissue to die. It can also cause a hole in the intestine. Bacteria can leak through this hole, causing serious abdominal infections. Switching to IV feedings can help. Some infants need surgery to remove the damaged intestine.
Necrotizing enterocolitis (NEC) is a serious gastrointestinal problem that mostly affects premature babies. The condition inflames intestinal tissue, causing it to die.
A hole (perforation) may form in your baby's intestine. Bacteria can leak into the abdomen (belly) or bloodstream through the hole. NEC usually develops within two to six weeks after birth.
In some infants, NEC is mild. Others experience severe, life-threatening symptoms. You pronounce the condition nek-ruh-TIZE-ing en-ter-o-ko-LIE-tis.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The small and large intestines are part of the digestive system. The intestines help turn food and liquids into waste. Your body removes this waste through poop.
Nearly all babies — 9 out of 10 — who get NEC are born early. The condition mostly affects babies:
In premature infants, NEC is a common gastrointestinal illness. It affects 1 in 1,000 premature babies. The risk is greatest for babies weighing less than 2 pounds.
The condition only rarely affects full-term infants. About 1 in 10,000 full-term babies get NEC.
Healthcare providers classify NEC into types based on when symptoms start and what causes the condition. The different types of NEC include:
Although rare, NEC outbreaks can happen in neonatal intensive care units (NICUs). NICUs provide advanced medical care for premature and critically ill babies. During an outbreak, several infants can develop NEC at the same time. Bacteria, such as e. Coli, or other germs may cause these uncommon outbreaks.
Healthcare providers don’t know exactly what causes NEC. We do know that premature infants have weaker immune systems. The immune system helps the body fight off infections.
An infant’s digestive system is also weaker. When premature babies get an intestinal infection, their immune and digestive systems have a hard time fighting it.
Oxygen-carrying blood also has a harder time reaching the intestines in premature babies. Diminished blood flow can damage intestinal tissue. This damage allows bacteria to leave the intestines and enter the abdominal cavity or bloodstream.
NEC typically occurs two to six weeks after birth, depending on the type and cause. Symptoms may come on over a few days or appear suddenly in babies who otherwise seem to be doing well.
NEC is a common problem among infants in NICUs. Your baby’s care team will be on the lookout for signs of this problem.
Symptoms of NEC include:
Your healthcare provider will examine your baby. They check for a swollen belly and other NEC symptoms.
Your provider may also order these tests:
An infant with NEC is at risk for other problems, such as:
Your baby’s intestines need time to rest and heal. The first step in treating NEC is to stop tube or oral feedings. Instead, your baby receives intravenous (IV) fluids and nutrients.
Your baby may also get these treatments:
About 1 in 4 babies need surgery to remove dead intestinal tissue and repair a hole. Your child’s provider may perform an ostomy procedure. This surgery:
When your baby is stronger, your provider will reattach the intestines and replace them in the abdomen.
If your child is too small (weighs less than 1 pound) or too ill for surgery, your provider may place a drain (catheter) in the abdomen. The drain lessens symptoms by removing unhealthy or infected fluids and gas. If your baby still needs surgery later, the surgery will take place when your baby is bigger and healthier.
If you are at risk for preterm birth, you may get corticosteroid injections. This medication boosts the health of the developing fetus. It may lower its chances of lung and intestinal problems.
An estimated 8 in 10 babies with NEC survive. Some of these babies will have long-term health problems from NEC.
You may want to ask your healthcare provider:
It can be upsetting to see your premature baby have a setback like NEC when they seem to be doing well. Care teams in NICUs have training to spot this problem and act quickly. Some babies get better with minimal treatment. Children who need surgery often go on to lead full lives. Some children have chronic digestive problems.
Last reviewed by a Cleveland Clinic medical professional on 05/18/2021.
Learn more about our editorial process.