Understanding Necrotizing Enterocolitis

This article is sponsored by MercyOne Des Moines Medical Center.

What to know about necrotizing enterocolitis, a gastrointestinal disease commonly found in preemies and newborns.

Fragile newborn babies may require treatment in the neonatal intensive care unit.  Sometimes during their hospitalization, a baby’s health will take a sudden dip. One common cause for an abrupt health change in newborns is necrotizing enterocolitis.

What is necrotizing enterocolitis (NEC)?

Necrotizing enterocolitis is a common and serious disease in newborn babies, occurring in approximately 1 in every 1,000 live births. NEC happens when inflammation of the bowel is triggered, causing infection and death of some of the intestine. Holes in the intestine may develop and allow leakage of bowel contents into the abdominal cavity. Bacteria may also cross into the bloodstream causing a body-wide infection.

More than 90% of NEC cases occur in premature babies born more than eight weeks early. Newborns, especially premature newborns, have a weaker immune system and immature intestinal tract increasing the likelihood of NEC.

The causes behind NEC are still unknown. With a weaker immune system and immature digestive system, the intestine is more vulnerable to injury and infection. When NEC is triggered, the premature baby’s defenses may have a hard time fighting the infection.


Symptoms to look out for include:

  • Bloating and pain in the stomach (abdominal distension)
  • Feeding intolerance
  • Apnea
  • Bloody stools
  • Low blood pressure

If any of these symptoms are noticed, do not hesitate to reach out to your baby’s provider. The sooner NEC is diagnosed, the faster treatment can begin.

How is NEC diagnosed?

NEC is typically diagnosed based on two factors: clinical symptoms (bloody stools, feeding intolerance, abdominal distension, etc.) and abdominal X-ray findings of pneumatosis (small bubbles of gas in the lining of the intestinal wall). Perforation of the intestine may also be seen on X-ray. NEC may also be diagnosed using ultrasound and operative findings.

Management and treatment

The first step is prevention. Breast milk has been shown to protect against the development of NEC. Limiting medications that disrupt the bacterial composition of the intestinal tract may be useful, such as avoiding antacid drugs and minimizing the overuse of antibiotics.

Despite taking these steps, NEC can still occur. Once NEC has been diagnosed, the primary treatments include stopping feedings to rest the bowel and prescribing antibiotics to treat an intestinal infection. Babies may need transfusions, medications for blood pressure support, or ventilator support. Sometimes surgery may be required to remove the damaged intestine or have a surgical drain placed in the abdomen. Extensive death of bowel can occur resulting in short bowel syndrome which can impact your baby’s overall health and in severe cases cause death.

Close communication with your health care team is essential for your baby’s health, especially in the first few days of this illness. Despite the potential severity of NEC, most babies survive and live healthy normal lives.

Dan Ellsbury MercyOne Children’s Hospital offers specialized pediatric care, 24/7 children’s emergency care, intensive care unit for neonatal and pediatric and maternity care.

About the Author: Dan Ellsbury, MD, is a neonatologist at Pediatrix Medical Group of Iowa and MercyOne Children’s Hospital. He has practiced neonatology for 20 years at MercyOne Children’s Hospital. Dr. Ellsbury and his wife Lisa have 16 children.

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