What is Necrotizing Enterocolitis (NEC)?

Necrotizing Enterocolitis (NEC) is a serious illness characterised by inflammation and damage to the tissues of the intestine. In severe cases parts of the intestinal tissue may die.

Who is affected and what are the risk factors?

NEC is mainly a condition affecting preterm babies, usually after the second week following birth. The earlier the baby is born, the higher the risk of developing NEC. About 5 in 100 very preterm born babies develop this condition. Where babies are very ill or fed formula rather than human milk, the risk is highest. 

Depsite the potentially severe illness, many babies with NEC will develop without serious complications later in life. However, although it is uncommon, NEC is one of the important causes of late death in preterm born infants.

What is the cause?

The causes of NEC are still not well understood. However three factors seem to come together in babies who develop NEC: low intestinal blood flow, presence of infection, and formula milk.

How is it diagnosed?

Sometimes it can be difficult to diagnose NEC because the symptoms, such as vomiting or abdominal distension, are found with many other feeding problems that are common in preterm born children.

Symptoms can also include an distended belly, diarrhoea, and blood in the stool (an important sign). The healthcare team will examine the abdomen regularly and use a stethoscope to listen to the bowel sounds. Infants who are developing NEC may appear to be very ill.

NEC has typical appearances on X-ray of the abdomen, although for some babies the diagnosis is only made at operation.

How is it managed?

When the healthcare team suspects NEC the first steps are to stop oral feeds, to start intravenous fluids (and nutrition) and to treat with antibiotics.  The team will organise X-rays and blood tests. Often, this treatment is necessary for 7-10 days if the diagnosis is confirmed. For most babies with NEC this is all that is necessary.

Other babies are sicker and need support for their breathing and intensive care for several days.

Some babies may become profoundly ill with NEC and one of two surgical treatments may be used.  The first is to insert a tube (called a ‘drain’) into the space outside the intestine to drain any fluid and relieve pressure on the bowel; this allows faster healing. The other option includes surgical removal of the affected part of the intestine, often followed at a later date by reattachment of the healthy bowel sections.

NEC can be a very serious condition and the healthcare team often start medical treatment first before the diagnosis is confirmed, only to confirm later that it was not actually NEC.

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