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Necrotizing enterocolitis (NE or sometimes NEC) is a rare condition that damages or kills cells and tissues in the colon or lower intestines. Most children are successfully treated and go on to live healthy lives.
NE develops most often in the second to third week of life. There seems to be an interaction between lower birth weight and higher risk. It affects close to 10% of infants who weigh less than 1500 g (3 pounds, 5 ounces) but may also occur in term and near-term babies.
Sometimes the infection can become severe and cause damage to the intestine. These children may have problems with digestion, growth and development.
In very severe cases, there can be a hole created in the wall of the intestines. This allows bacteria to get into the abdomen.
Necrotizing enterocolitis is seen in only one out of 4,000 births in the United States. However, it is still the most common gastrointestinal emergency among premature infants in neonatal intensive care units (NICU). It can be fatal for some infants, so aggressive treatment is important.
Some children may require continuing treatment after release from the hospital. This ongoing care is an important part of returning your child to a normal life.
Doctors don’t yet know the exact cause for NE. Many think that low blood flow to the intestinal walls weakens them. This decrease in blood flow to the bowel keeps it from producing the mucus that protects the gastrointestinal tract. This may be one reason why babies who have gone through difficult deliveries with lowered oxygen levels develop necrotizing enterocolitis.
Others think that since it is seen so often in premature births, it may be related to the gut simply not being as mature as it would be closer to term.
Symptoms usually occur in the first 2-3 weeks of life. They include:
NE can be a very fast-moving disease and needs to be treated early. If there is any doubt at all in your mind, call your child’s physician or go to an emergency room.
The first step in diagnosing necrotizing enterocolitis is a thorough history and physical examination. Your child’s physician will look at the belly to see if it is large and extended, an indication of gas in the intestine. The doctor may place a stethoscope on the belly to listen for bowel sounds. Looking for redness or other color changes around the belly can help with the diagnosis.
The medical history is another important part of the early diagnosis. You will be asked about how often your baby has a bowel movement. Is there a red color that could be blood in the stool? Have you noticed changes in energy level? Is your baby feeding well?
If NE is suspected, an X-ray of the abdomen will be taken. That can show your child’s doctor any blockages, excess gas, or any perforations, or holes, in the intestine. Doctors may need to take more than one X-ray to track the course of the disease.
A complete blood count may also be ordered. An elevated white blood cell count indicates an infection is happening. Low red cells can be a reason to suspect blood loss, as can low platelet counts.
A sudden decrease in the amount of sodium in the blood is another worrisome sign. This is consistent with leakage of blood from the very smallest vessels known as the capillaries.
Occult blood tests may be performed on your baby’s bowel movements. If blood is found, that can mean a hole (perforation) somewhere in the intestine that may require surgery.
Other treatments will depend on exactly what is happening. If there is bleeding, blood transfusions may be given. Medications may be used to keep blood pressure, heart rate and oxygen in the blood at proper levels.
While these treatments are ongoing, tests will monitor your child’s health and help with further decisions. X-rays of the abdomen will track the amount of gas building up in the baby’s stomach. Blood tests will follow signs of infection (white blood cell counts), the efficiency of your baby’s breathing (blood gas studies measuring oxygen and carbon dioxide) and lactic acid (high levels suggest disease progression).
If surgery is needed, the pediatric surgeon will look closely at the intestine. The doctor will take out only the damaged parts. This is done so that the remaining tissue can start to work again. This preserves, to the greatest amount possible, your child’s digestive system.
The surgeon may make an opening in the wall of the abdomen. This lets the bowel recover and heal. Routing the intestine so it empties into a bag outside of the body can be frightening for parents. However, this is most often temporary. Another surgery may be needed later to close the opening.
Newborns most often develop necrotizing enterocolitis three to 12 days after birth. Although it is a rare condition, necrotizing enterocolitis is the most common gastrointestinal disease that occurs in newborns.
Scientists don't know the exact cause behind all cases of necrotizing enterocolitis, but they think that restricted blood flow to the developing intestinal walls might weaken them, leaving them vulnerable to inflammation and damage.
Bloating or swelling in your child's stomach area, reduced or difficult feeding, vomiting and blood in bowel movements are common symptoms.
Physicians conduct physical exams, blood and stool tests, as well as take X-rays, before making a diagnosis.
Mild cases can be treated medically, but severe damage to the colon requires surgical repair.
Babies born prematurely or those babies who have a preexisting illness have a higher risk for necrotizing enterocolitis. Newborns who underwent a difficult delivery (low oxygen births) or who underwent certain types of blood transfusions have a higher risk factor than babies who had normal deliveries.