NEC

Alternative names
Necrotizing enterocolitis

Definition
Necrotizing enterocolitis is an acquired disease, primarily in premature infants or sick newborns, in which intestinal tissue dies.

Causes, incidence, and risk factors

In necrotizing enterocolitis, the lining of the intestinal wall dies and the tissue sloughs off. The cause for this disorder is unknown, but it is thought that a decreased blood flow to the bowel keeps the bowel from producing the normal protective mucus. Bacteria in the intestine may also be a causative factor.

At risk are small, premature infants, infants who are fed concentrated formulas, infants in a nursery where an outbreak has occured (suggesting an infectious cause), and infants who have received blood exchange transfusions.

Symptoms

     
  • Abdominal distention  
  • Vomiting and feeding intolerance  
  • Blood in the stool (visible or microscopic)  
  • Lethargy  
  • Temperature instability  
  • diarrhea

Signs and tests

     
  • Abdominal x-ray  
  • Stool for occult blood test (guaiac)  
  • Elevated white blood cell count in a CBC  
  • Thrombocytopenia (low platelet count)  
  • Lactic acidosis

Treatment
In an infant suspected of having necrotizing enterocolitis, feedings are stopped and the bowel is decompressed of gas by inserting a small tube into the stomach. Intravenous fluid replaces formula or breast milk. Antibiotic therapy is started. The infant’s condition is monitored with abdominal x-rays, blood tests, and blood gases.

If intestinal perforation (hole) or peritonitis (inflammation of the abdominal wall) develops, surgery is indicated. The dead bowel tissue is removed and a colostomy or ileostomy is performed. The bowel is then reconnected several weeks or months later when the infection and inflammation have healed.

Expectations (prognosis)
Necrotizing enterocolitis is a serious disease with a death rate approaching 25%. The outcome is improved by aggressive, early treatment.

Complications

     
  • Intestinal perforation  
  • Sepsis  
  • Peritonitis  
  • Intestinal stricture (a narrow area that may lead to bowel obstruction)

Calling your health care provider
This disorder usually develops in an infant that is already ill or premature, and most often develops while the infant is still in the hospital. If any symptoms of necrotizing enterocolitis develop, especially in an infant that has recently been hospitalized for illness or prematurity, go to the emergency room or call the local emergency number (such as 911).

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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