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Necrotizing Enterocolitis - Symptoms and Treatment


A gastrointestinal disease that mostly affects premature infants, NEC involves infection and inflammation that causes destruction of the bowel ( intestine ) or part of the bowel. The disease usually occurs in premature newborns. The cause is not understood. Diminished blood flow to the intestine in a sick premature newborn may result in injury to the inner layers of the intestine, allowing bacteria that normally exist within the intestine to invade the damaged intestinal wall. If the injury progresses through the entire thickness of the bowel wall and the intestinal wall perforates, intestinal contents leak into the abdominal cavity and cause peritonitis. Necrotizing enterocolitis can also lead to infection of the blood (sepsis).

Although it affects only one in 2,000 to 4,000 births, or between 1% and 5% of neonatal intensive care unit (NICU) admissions, NEC is the most common and serious gastrointestinal disorder among hospitalized preterm infants. NEC typically occurs within the first 2 weeks of life, usually after milk feeding has begun (at first, feedings are usually given through a tube that goes directly to the baby's stomach). About 10% of babies weighing less than 1,500 grams (3 lbs., 5 oz.) experience NEC. These premature infants have immature bowels, which are sensitive to changes in blood flow and prone to infection. They may have difficulty with blood and oxygen circulation and digestion, which increases their chances of developing NEC.

Necrotizing enterocolitis is a serious infection that can produce complications in the intestine itself such as ulcers, perforations or holes in the intestinal wall, and tissue necrosis. It can also progress to life-threatening septicemia. The name of this disease is derived from necrotizing, meaning damage and death of cells, entero, referring to the intestine, and colitis, meaning inflammation of the colon (lower part of the intestine).

Necrotizing enterocolitis is the most common gastrointestinal (GI) emergency in the neonatal intensive care unit. It is a serious disease that predominantly affects premature infants, but it is also seen in full-term infants. Necrotizing enterocolitis can affect any portion of the gastrointestinal tract or the entire gastrointestinal tract. In severe cases, it is associated with a mortality rate of 50%.

Causes of Necrotizing Enterocolitis

It is not clear exactly what causes NEC. It is believed to occur when the immune and digestive systems do not develop properly. This can happen when a baby is born prematurely or when there are complications during pregnancy or delivery. Experts do not know if feeding a newborn formula can lead to necrotizing enterocolitis, but they do know that the disease is much less common in babies who are fed breast milk.

Find common causes and risk factors of Necrotizing Enterocolitis:

  • Is considered "high risk" and has started taking milk by mouth or feeding tube .
  • May be associated with use of indomethacin or early dexamethasone treatment .
  • Enteral feeding (although approx. 10% of cases occur in infants never fed) .
  • Had a difficult delivery and had lowered oxygen levels during labor.
  • Has a gastrointestinal infection .

Signs and Symptoms of Necrotizing Enterocolitis

Sign and symptoms may include the following :

  • Diarrhea .
  • Poor feeding.
  • Lethargy.
  • Abdominal distension or swelling .
  • Feeding intolerance.

Treatment for Necrotizing Enterocolitis

Treatment may include:

  • Intravenous fluids (IV) for nutrition and fluid replacement.
  • Frequent x-rays to monitor the progress of the disease.
  • Stopping feedings.
  • Antibiotic therapy to treat possible infections.
  • Extra oxygen or mechanically assisted breathing if the abdomen is so swollen that it interferes with breathing.
  • Nasogastric (NG) tube (nose into stomach) to keep stomach empty.
  • In severe cases, platelet and red blood cell transfusion may be necessary.
  • Checking stools for blood.

 


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