Necrotizing Enterocolitis

What is necrotizing enterocolitis?

Necrotizing enterocolitis, also referred to as NEC (pronounced /nek/), is a serious gastrointestinal condition that primarily affects premature infants. It involves inflammation and sometimes infection of the intestines, which can lead to death of the tissue (called necrosis). In severe cases, a hole can form in the intestinal wall. NEC can be mild to severe and may require immediate medical or surgical intervention. 

Who is at risk for developing NEC?

Premature and very small infants have the highest risk of developing NEC. Those at highest risk are born before 32 weeks of gestation, but NEC also can occur in later preterm infants (32–37 weeks) and very rarely in infants born full-term. Other risk factors for developing NEC include low birth weight, formula feeding, and other health issues such as respiratory distress syndrome or heart problems. The gut microbiome (bacteria that normally live in the intestines) is likely involved in NEC, but research in this area is ongoing. 

How common is NEC?

In the smallest premature infants, NEC occurs in up to 1 in 10 births.

What are the signs and symptoms of NEC?

Many clues may cause your baby’s medical provider to look for NEC. Some of the more common signs are: 

• Abdominal swelling or bloating
• Discomfort with feeds or vomiting
• Blood in the stool
• Decreased energy or activity
• Irritability or signs of discomfort
• Fever or low body temperature

How is NEC diagnosed?

Diagnosis typically starts with a physical examination by your baby’s healthcare provider. Next steps may include imaging tests, such as an abdominal X-ray or ultrasound. Abdominal X-rays may show air bubbles in the wall of the intestines (called pneumatosis intestinalis). Your baby’s healthcare team also may order blood tests to check for infection or other abnormalities.

What are the treatment options for NEC?

Treatment depends on the severity of NEC. Options may include:

• Gut rest: Eating (by mouth or feeding tube) may be stopped temporarily to rest the intestines, and intravenous (IV) nutrition may be provided as an alternative.
• Antibiotics: These are typically given through an IV to treat or prevent infection.
• Surgery: In severe cases, surgery may be necessary to remove damaged portions of the intestine.

Can NEC be prevented?

Not all cases of NEC can be prevented, but steps can be taken to reduce the risk of NEC. One is feeding babies breast milk or donor breast milk In addition, some studies suggest using probiotics in premature infants, but discussions on this topic are ongoing. Talk to your child’s healthcare provider for the most updated recommendations.

What is the prognosis for infants with NEC?

The prognosis for infants with NEC varies based on the severity of the condition and how quickly treatment begins. Some infants recover completely, while others may experience complications that can affect their long-term health. Early detection and treatment are crucial for improving outcomes. 

Where can I find support and resources?

The best resource for your child’s health is their healthcare provider. Always consult your pediatrician or neonatologist for personalized advice and support. Organizations like the March of Dimes or local NICU support groups also can provide valuable information and emotional support for families affected by NEC. 

References

• Alganabi, M., Lee, C., Bindi, E., Li, B., & Pierro, A. (2019). Recent advances in understanding necrotizing enterocolitis. F1000Research, 8, F1000 Faculty Rev-107. https://doi.org/10.12688/f1000research.17228.1
• Bazacliu, C., & Neu, J. (2019). Necrotizing enterocolitis: long term complications. Current pediatric reviews, 15(2), 115–124. https://doi.org/10.2174/1573396315666190312093119
• Cai, X., Liebe, H. L., Golubkova, A., Leiva, T., & Hunter, C. J. (2023). A review of the diagnosis and treatment of necrotizing enterocolitis. Current pediatric reviews, 19(3), 285–295. https://doi.org/10.2174/1573396318666220805110947
• Holman, R. C., Stoll, B. J., Curns, A. T., Yorita, K. L., Steiner, C. A., & Schonberger, L. B. (2006). Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatric and perinatal epidemiology, 20(6), 498–506. https://doi.org/10.1111/j.1365-3016.2006.00756.x
• Hu, X., Liang, H., Li, F., Zhang, R., Zhu, Y., Zhu, X., & Xu, Y. (2024). Necrotizing enterocolitis: current understanding of the prevention and management. Pediatric surgery international, 40(1), 32. https://doi.org/10.1007/s00383-023-05619-3
• Neu, J., & Walker, W. A. (2011). Necrotizing enterocolitis. The New England journal of medicine, 364(3), 255–264. https://doi.org/10.1056/NEJMra1005408
• Roberts, A. G., Younge, N., & Greenberg, R. G. (2024). Neonatal necrotizing enterocolitis: an update on pathophysiology, treatment, and prevention. Paediatric drugs, 26(3), 259–275. https://doi.org/10.1007/s40272-024-00626-w

Authors: Samantha Saul, MD, and Tess Coker, MD
Editor: Amanda Deacy, MD
August 2024