Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death).

Signs and symptoms

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The condition is typically seen within days after birth, and initial symptoms include feeding intolerance, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.

Treatment

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Treatment can be either medical or surgical. Initial medical treatment includes bowel rest and decompression with intermittent gastric suction. Immediate treatment with intravenous antibiotics, including vancomycin and gentamicin will begin, as well as periodic (every 6-8 hours) abdominal x-rays monitoring for intestinal perforation. The deteriorating bowel can be visualized on X-ray as an area of "bubbling" within the wall of the bowel known as pneumatosis intestinalis. After several days, medical treatment will begin to show slow down and reversal of bowel deterioration in many cases. Where the disease is not halted through medical treatment alone, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is required. This may require a colostomy, which may be able to be reversed at a later time. Some children may suffer later as a result of short bowel syndrome if extensive portions of the bowel had to be removed.

Cause

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NEC has no definitive known cause. A contagious agent is suspected, as cluster outbreaks in neonatal intensive care units (NICUs) are seen, but it is suspected that a combination of contagion, inherent weakness in the bowel, and some timing of the initiation of oral feedings are factors. NEC is almost never seen in infants before oral feedings are initiated.

Prognosis

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Typical recovery from NEC if medical, non-surgical treatment succeeds includes 10-14 days or more NPO, and then demonstrated ability to resume feedings and gain weight. Recovery from NEC alone may be compromised by other multiple conditions that frequently accompany prematurity. If surgery is required, the prognosis is poor. Surgical NEC carries a significant mortality, and survivors who had surgery may suffer from long term morbidity such as short-bowel syndrome, and neurodevelopmental disability.

Pediatrics | Digestive diseases

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