Necrotizing Enterocolitis

Alternative names: NEC

Definition: 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, pathologic bacteria in the intestine may also be a causative factor. Risk factors include small, premature infants, outbreaks among other infants in a nursery (suggesting an infectious cause), the feeding of concentrated formulas, 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)
• low or elevated white blood cell count in a CBC
• thrombocytopenia (low platelet count)
• lactic acidosis

Treatment: In an infant with suspected Necrotizing Enterocolitis, feedings are stopped and the bowel is decompressed of gas by inserting a small tube into the stomach. Intravenous fluid is started to replace feedings of 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) develop, 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 of over 30%. The outcome is improved by aggressive, early treatment.

Complications:

• intestinal perforation
• sepsis
• peritonitis
• intestinal stricture (a narrow area that may lead to bowel obstruction)

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