Necrotizing Enterocolitis (NEC) is a condition that premature babies are at risk of getting. This condition can cause intestinal tissue death and can also lead to holes in the intestines. Bacteria can seep out of the digestive tract and cause an abdominal infection in these patients. Some babies will need surgery to correct the secondary conditions that are caused by NEC.
This condition usually occurs about two to six weeks after birth. The type of NEC can dictate when it appears. Symptoms of this condition can come on fairly quickly in babies that seem to be healthy. This is a common problem in neonatal intensive care units (NICUs), and the fragile nature of premature babies makes it a serious condition. The common symptoms of NEC are:
There is more than one type of NEC. The various types of NEC can become symptomatic at different stages of a premature child’s development.
This version of NEC affects babies born before 28 weeks of pregnancy. The symptoms show up 3 to 6 weeks after birth. The baby will appear to be stable and then suddenly become sick.
This type of NEC happens after a blood transfusion is given to a child who is anaemic. About 1 in 3 premature babies will develop this condition within three days of receiving a blood transfusion.
This presentation of NEC is not common and often causes symptoms within the first week of life or even before the first feeding.
Infants that have birth defects might also suffer from NEC, even if they are full-term. This is most common in children with intestines that have formed outside the body or in those who suffer from low oxygen levels during birth.
The mechanisms that cause NEC are not well-understood by experts. Premature babies do have weakened immune systems, and they are more prone to developmental issues and birth defects. It is thought that these two challenges can lead to higher risk for NEC.
Additionally, premature infants have weaker digestive systems than full-term children. This can lead to an increased risk for a variety of digestive abnormalities and complications along with NEC. Oxygen-carrying blood has a harder time reaching the intestines of premature babies, and this might cause difficulty in fighting off bacteria that have entered the abdominal cavity or the bloodstream.
The two primary risk factors for this condition are premature birth and early feeding of children without a fully matured gut. As previously mentioned, babies with low oxygen levels at birth and those who suffered difficult deliveries are also at increased risk.
A physical examination will be performed by a doctor, and blood tests will be taken from affected infants. A faecal test will also usually be taken to look for blood in the faeces. X-rays can also show issues in the abdominal cavity that might be leading to NEC or signs of inflammation, like gas around the intestine or in the abdomen.
Prevention of this condition is not usually possible. Premature births are never intentional, and not all babies who are born prematurely will suffer from NEC. Some mothers who are judged to be at risk for premature delivery can be placed on bed rest and treated with corticosteroid injections to try to prevent early delivery with complications.
Treatment is focused on allowing the intestinal tract to rest. Nasogastric tube feeding is often the best way to make sure that the infant gets nourishment while the gut has time to heal. Antibiotics will usually also be given to kill bacteria that have invaded the gut or the abdominal cavity.
Some babies will need surgery to repair holes in the gut and to clean up an infection in the abdomen. A stoma will be created during these surgeries to allow faecal matter to be eliminated outside the body until the gut has healed. This hole will later be closed, and the gut will be reattached to the formerly damaged part of the intestines. Infants who are too small to have stoma surgery will usually have a drain tube placed in their abdomen that allows fluids and gas to escape while the gut heals.