Dr Ira Shah
Consultant Pediatrician
Editor- Pediatric Oncall

What is necrotizing enterocolitis?
Necrotizing (pronounced as neck-row-tie-sing) enterocolitis (pronounced as ant-err-o-coal-i-tis) is a serious intestinal disease that predominantly affects premature babies. It is also called in short as NEC. In this problem, the intestines stop functioning and lead to problems of infection; air perforation and untreated can lead to death.

What is the cause of NEC?
The exact cause of NEC is not known. However it has been found to occur more commonly in premature babies usually within 3-10 days after birth. It is thought that intestines of preemies are immature and these babies are more prone to low body temperature, feeding problems and low blood pressure. These babies on feeding have increased intestinal oxygen requirement which may not be met leading to intestinal tissue hypoxia (low oxygen) which damages the intestine and further damage (by intestinal bacteria. It has been found that breast milk fed babies tend to have lesser changes of NEC due to presence of protective factors in human milk. However in most babies, NEC occurs sporadically.

What are the symptoms of NEC?
Most babies with NEC have abdominal distension, vomiting and blood in stools. They soon become lethargic, may have episodes of breathing cessation and also low blood pressure. On touching the abdomen, there may be pain and there may be redness over the abdomen. The body temperature may become lower or there may be fever. With severe infection, the blood sugar will be affected and sepsis will set in.

What are the complications in NEC?
Severe NEC can lead to spread of infection all through the body; there may be perforation of the intestines and even gangrene of large part of intestines. On healing, there may be stricture in the intestine, difficulty in absorbing food or even a very small functioning intestine left behind (small gut syndrome).

Can NEC develop in full term babies?
On rare occasions, NEC can develop in healthy full term babies with no risk factors.

What is the treatment of NEC?
Treatment of NEC would consist of giving rest to the intestines by keeping the baby off feeds. Baby is given intravenous fluids to maintain nourishment, blood sugar as well as blood pressure. The intestines are decompressed of fluid and air by putting a tube into the stomach. Antibiotics become the mainstay of treatment. In severe NEC with intestinal perforation or anticipated gangrene of the intestine, surgery to remove damaged part of the intestine may be required.

Last updated: 1st September 2010