Necrotising enterocolitis

What is necrotising enterocolitis

Necrotising enterocolitis (NEC) is inflammation of the bowel.

Necrotising means causing damage to tissue

Entero refers to the small intestine

Colorefers to large intestine

Itis means inflammation.

NEC may only affect the innermost lining of the bowel or the entire thickness of the bowel and variable amounts of the intestine.

Why do premature babies get NEC?

Premature infants have immature and fragile intestines. They are sensitive to changes in blood flow and to infection. We usually do not know why an individual baby develops NEC.

Did my breast milk cause NEC?

Babies who are given breast milk are less likely to get NEC than babies who are fed formula. However, it does not completely prevent it.

Is NEC serious?

A few babies can lose some of their intestine from NEC. Unfortunately some babies will also die from NEC. As this is a serious problem, doctors may start treatment simply on the suspicion that your baby may be developing symptoms of NEC. This suspicion is sometimes referred to as “possible NEC”.

What will happen to my baby if he or she has NEC?

Your baby may show any or all of the following:

general signs of being “sick”: less active, more apnoea, increased respiratory problems, difficulty keeping the body temperature normal

a change in the ability to absorb milk. Increasing aspirate of fluid from the stomach which is often green in colour

a tense and distended abdomen

discolouration of the abdomen

blood in the stool.

What can be done to treat NEC?

If your baby’s doctor thinks your baby might be developing NEC, any or all of the following might be done:

all regular feeds are stopped for several days. Your baby will have a drip for intravenous feeding

a tube will be placed into the stomach either through the mouth or nose to remove air and fluids from the stomach and intestine

X-rays of the abdomen

a sample of blood will be sent to the laboratory for evidence of infection

antibiotics will be given intravenously

more frequent blood tests to look for signs of infection and imbalances in the body’s chemistry

stools are checked for blood.

What happens if part of my baby’s intestine is damaged?

If only the inner lining of intestine is damaged, it will heal normally. If the entire thickness of a piece of intestine dies, the intestine may perforate (develop a hole in it) and your baby will need surgery to remove that piece of bowel. The ends of the intestine above and below the damaged piece may be brought to the surface of the skin (called an ostomy). At some later time, after your baby has recovered and grown bigger, the two ends of the bowel are sewn back together and put into the abdomen in a second operation.

Occasionally, the ends of the bowel can be sewn together during the first surgery, and then no further surgery is needed. The surgeon decides this at the time of surgery.

Are there any long term problems from NEC?

Most babies recover from NEC and do not have further problems; but, future problems are possible, especially if there has been surgery to the bowel. These include:

short bowel - which means there is too little bowel to absorb all the nutrients needed by the body long term use of intravenous feeding scarring and narrowing of the bowel causing “obstruction” or blockage of the bowel scarring within the abdomen causing later pain.