INTESTINAL INFLAMMATION (Necrotizing Enterocolitis)

Definition: An acute inflammation of the inner lining of the bowel with the presence of

membrane-like areas and superficial ulcerations. Also called NEC.

1. What caused this condition?

In most cases, the baby was born early or premature and has been given some type of feeding. The lining or barrier of the intestinal tract has been injured, and this injury has allowed bacteria to get into the wall of the intestine. The bacteria cause an infection, injury, or weakness to the intestinal wall and an inflammatory reaction in those areas.

2. What tests need to be done to further define the condition?

The confirmatory signs of necrotizing enterocolitis (NEC) are seen on X rays of the abdomen. When NEC is suspected, a culture (test for bacteria in the bloodstream), a complete blood count (CBC), and a test to determine the level of inflammation (CRP) may also be performed on the infant’s blood. A series of X rays of the abdomen and blood are done for several days to monitor this condition. A consultation with a pediatric surgeon may also be requested.

3. What potential dangers does NEC pose?

NEC is a serious concern and will cause some setback in the baby’s condition. There are “mild” causes of NEC involving a limited portion of the intestine that improve in twenty-four to forty-eight hours of starting treatment. There are other cases of NEC that involve extensive areas or all of the intestine and are progressive. These cases require surgery with possible removal of intestine and are life threatening. When all of the intestine is involved, there may be no treat- ment possible, and it is then a fatal condition.

4. What is the treatment for NEC, and how long will it take for my baby to recover?

The treatment for NEC is stopping any feedings, starting antibiotic therapy, administering medications to stabilize the blood pressure and blood components (e.g., platelets and plasma) to prevent bleeding, and supporting breathing. Often a pediatric surgeon will be requested to evaluate the baby. Monitoring with repeat X rays of the abdomen, blood testing, and physical examinations are performed, often as frequently as every six hours. A surgery is needed if a hole (perforation) occurs in the intestine or if the baby is not getting better. If surgery is performed, frequently a section or sections of intestine may be removed and the ends of the intestine brought up to and through the abdominal wall. The surgeon may decide to place a piece of rubber drain in the abdominal space if the infant is unstable and will not tolerate a major operation. The length of recovery may vary from ten to fourteen days in the cases that respond to medicines, to a prolonged (years long) dependence on IV fluids in cases where there has been extensive involve- ment or removal of intestine.

5. Are there any potential side effects of the treatment?

There are many side effects that are related to the infection and inflammation from the NEC. Several of the antibiotics used to treat the infection require blood levels to be monitored and may result in some hearing loss if too high (due to toxic effects of the antibiotics on the nerve function within the inner ear). Breathing failure, kidney failure, low blood pressure, and bleeding problems are common issues that occur with NEC. When needed, surgery may be performed in a less than stable situation. Blood and fluid losses due to bleeding abnormalities and inflammation may further worsen the situation. Decreased blood pressure and flow could also cause injury to the brain. The baby may need prolonged IV nutrition, which could lead to liver injury, a need for stable IV access, and subsequent infections of the bloodstream. A complication that may occur four to six weeks after the infant recovers is a narrowing in the intestine that requires surgery to correct.

6. Is it possible that this condition could get worse?

When NEC is first suspected or diagnosed, it is difficult to predict if it will respond or progress despite adequate treatment. Close observation of the baby is needed in the first twenty-four to forty-eight hours after beginning treatment. Often the condition does get more serious before improving.

7. Do we need to consult a neonatologist (newborn specialist) or gastroenterologist (specialist of the digestive system)?

Neonatologists should be consulted and assist in or assume the care of a baby with NEC or suspected NEC. A pediatric surgeon is often consulted as well. A gastroenterologist is generally not required during the critical period and may become involved after recovery if the baby is not able to grow on feedings or if concerns of liver injury from long- term IV nutritional support is present.

8. Will I be able to breastfeed my baby during this illness?

No. The stoppage of any feeding, breast or formula, takes place when NEC is suspected or confirmed. Resting of the intestinal tract and antibiotics are the main therapies for NEC. The baby may not be able to feed for a minimum of seven days in suspected NEC. If NEC is confirmed, a minimum of ten to fourteen days is required.

9. After discharge from the hospital, what kind of follow-up will be needed?

If a narrowing in the intestinal tract is suspected or if there is evidence of an intestinal blockage, an X ray test with dye and consultation with a surgeon will be necessary. If there are continued issues regarding how well the infant is able to digest and absorb feedings or if the infant is sent home on IV nutrition, then a gastroenterologist may be necessary. Attention to developmental issues is also important. 

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