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Necrotizing Enterocolitis in Premature Babies

Necrotizing enterocolitis (NEC) is a very serious illness that most commonly occurs in the intestines of preterm babies.

Necrotizing = damage and death of cells
Entero = referring to the intestine
Colitis = inflammation of the lower part of the intestines (colon)

NEC may lead to serious health problems and complications, including:

  • Sepsis (a potentially life-threatening condition where the body’s response to an infection damages the internal organs)
  • Intestinal strictures (narrowing in the intestines making it difficult for food to pass)
  • Perforations (holes) in the intestines
  • Growth failure and developmental delays

Necrotizing enterocolitis may even lead to death.

What Is Necrotizing Enterocolitis?

With necrotizing enterocolitis, the tissues of the intestine are weakened by decreased blood flow or oxygen. These weakened areas can become damaged by bacteria in the food the baby was fed—sometimes becoming severely damaged and possibly dying. This severe tissue damage and death can lead to a perforation (hole) in the intestine through which bacteria—bacteria not intended to be outside of the intestinal tract—can pass into the baby’s abdomen, causing a severe abdominal infection. This can progress very rapidly and be overwhelming to the baby.

What Are the Symptoms of Necrotizing Enterocolitis?

Symptoms of necrotizing enterocolitis can vary from baby to baby, and some of those symptoms may seem like signs of other, more common digestive problems.

Signs that a baby could have necrotizing enterocolitis include:

  • Trouble feeding and gaining weight
  • A swollen, tender, or red tummy
  • Distended abdomen (abnormally swollen stomach)
  • Being lethargic/being less active than expected or usual
  • Constipation
  • Diarrhea, or dark or bloody stools
  • Ileus (temporary lack of normal muscle contractions in the intestines)
  • Green vomit (a sign there may be bile in the vomit)
  • Food staying in the stomach longer than expected
  • Unstable or low body temperature
  • Abnormal breathing or pauses in breathing (apnea)
  • Slowed heart rate (bradycardia)
  • Low blood pressure (hypotension)
  • Shock (in advanced cases of NEC)

What Causes Necrotizing Enterocolitis?

There is no single factor that consistently causes premature babies to develop necrotizing enterocolitis. Instead, many factors can contribute to premature babies developing necrotizing enterocolitis, including:

  • Being fed formula or fortifiers based on cow’s milk
  • Their premature (underdeveloped) intestines
  • Restricted oxygen or blood flow to the intestines at birth
  • Injury to the intestinal lining
  • Bacterial or viral infections in the intestines

The link between feeding preterm babies cow’s milk and necrotizing enterocolitis has been known to science and the industry for years. But the makers of Enfamil and Similac baby formula and fortifiers did not place a warning on their products. This failure to warn has parents filing lawsuits.

One study of more than 900 premature infants found that:

  • Preterm infants fed baby formula (based on cow’s milk) were 6 to 10 times more likely to develop NEC than premature babies who were fed only breast milk.
  • Preterm infants fed baby formula (based on cow’s milk) were 3 times more likely to develop NEC than premature babies who were fed both breast milk and baby formula.

How is Necrotizing Enterocolitis Diagnosed?

When a preterm infant shows signs of necrotizing enterocolitis, the diagnosis can be confirmed by x-ray. Doctors can identify NEC by the look of the intestine. In advanced or severe cases of necrotizing enterocolitis, air may escape from the intestine and show up in the large veins of the abdominal cavity or liver. Also, the doctor may insert a needle into the baby’s belly to withdraw fluid to determine if there is a hole in the intestine (checking for waste or bacteria).

What Is the Treatment for Necrotizing Enterocolitis?

Treatment for necrotizing enterocolitis includes:

  • Temporarily stopping all feedings
  • Inserting a tube through the baby’s nose or mouth into the stomach to remove air and fluid from the stomach and intestine
  • IV fluids
  • Antibiotics

The doctors will examine the baby often, and there will be frequent abdominal x-rays. A pediatric surgeon may be brought in to determine whether surgery is needed. The baby’s stool (poop) will be examined for blood and the baby’s tummy checked for swelling. The baby may need extra oxygen or a ventilator. They will also test the blood frequently to check for bacteria and for anemia. 

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