Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death).
Signs and symptoms
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
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
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.
More on
[ Necrotizing enterocolitis ]
MedlinePlus - Diagnosis and treatment of necrotizing enterocolitis.
Texas Pediatric Surgical Associates - Necrotizing Enterocolitis - Provides definition, probable causes, signs and symptoms and management, with a special note for parents.