Necrotizing Enterocolitis in the Newborn

Necrotizing enterocolitis (NEC) is a serious illness in newborns. It happens when
tissue in the large intestine (colon) gets inflamed. This inflammation damages and
kills some tissue in your baby’s colon.

Any newborn can get NEC. But it’s most common in very sick or premature babies. This
is especially true for babies who weigh less than 3 pounds, 4 ounces (1,500 grams).
It is rare in older, larger babies. The smaller and earlier the baby, the higher the
risk for NEC. 

No one knows exactly what causes
NEC. It may happen if not enough blood and oxygen reach your baby’s immature intestinal
tissues. Contact between bacteria from the environment and the immature tissues seems
cause the baby’s body to respond with an inflammatory response. This can harm the
tissues and cause them to die. When this happens, a hole forms in the intestine. This
can cause a severe infection in your baby’s belly (abdomen).

Several things may raise your baby’s risk for NEC.

Premature birth

Premature babies are less mature than full-term babies. This means they may have trouble
with blood and oxygen circulation. Their body is not always ready for digestion and
fighting infections. This increases their chance of having NEC.

Formula feeding

Any premature baby is at risk
for NEC. But babies who don’t get human milk, especially their mother’s own milk,
more likely to get NEC. Human milk contains substances that help fight infection and
help intestinal cells mature. It’s also easier to digest.

Difficult birth or low oxygen levels at birth

Babies who had a difficult birth or low oxygen levels at birth are more likely to
get NEC. When there is too little oxygen, the body sends blood and oxygen to the brain
and heart first. This reduces the blood flow to the intestinal tract. This can cause
less oxygen in blood to reach the colon.

Infections in the intestine

Babies with infections in their intestines are more likely to get NEC.

Each child may experience symptoms
differently. Symptoms often show up in the first few weeks of life. They may

  • Belly bloating or swelling (abdominal
  • Food doesn’t move through to the intestines
  • Greenish-colored fluid (bile) in the stomach
  • Bloody bowel movements

Signs of infection include:

  • Breathing that stops and starts (apnea)
  • Slow heart rate
  • Sluggishness (lethargy)

The symptoms of NEC may be similar
to symptoms of other conditions. Make sure your child sees their healthcare provider
a diagnosis.

Your baby’s healthcare provider
will check them for signs of NEC.

Your child may need an abdominal
X-ray. An X-ray can show if your child’s intestine has a bubbly appearance. It can
show signs of air or gas in the large veins of your child’s liver. Air may also be
the outside of the intestines in your child’s belly. This is a sign of a hole in the

Your child’s healthcare provider
(surgeon) may also put a drain into their abdominal cavity. This is to remove fluid
your child’s belly that may be infected and causing damage.

Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
condition is. NEC may quickly get worse and require surgery. So care of NEC requires
team that includes pediatric surgeons. If your baby is at a hospital that doesn’t
pediatric surgeons, they must be transferred right away to one that does. In the U.S.,
this means a hospital with a level 4 NICU or neonatal intensive care unit.

Initial treatment may include:

  • Stopping feedings
  • Running a tube from your child’s nose
    to his or her stomach (nasogastric or NG tube). This is done to keep your child’s
    stomach empty.
  • Giving your baby IV (intravenous)
    fluids and nutrition
  • Giving antibiotic medicines for
  • Taking X-rays to check how the
    condition is progressing
  • Giving extra oxygen or using a
    breathing machine. This is done if your child’s belly is so swollen that it
    interferes with breathing.
  • Isolating your baby. This is done to
    keep any infection from spreading.

If your baby has severe NEC, they
may need:

  • Surgery to take out the damaged
    intestine or bowel
  • A procedure that connects part of the
    intestine or bowel to an opening on the belly (ostomy)
  • Draining of the abdominal (peritoneal)

NEC can cause a hole to form in your baby’s intestines. This makes bacteria inside
the intestinal tract leak into your child’s intestinal wall and sometimes out into
the abdominal cavity. This causes an infection. This can harm a small or large part
of the intestine. It can happen quickly.

An infection in the intestines is hard for a baby to fight. Even with treatment, there
may be serious problems. Some of these issues include:

  • A hole in the intestine
  • Scars or narrow areas (strictures) in the intestine
  • Not being able to absorb food and nutrients. This can happen if large amounts of your
    child’s intestine have to be removed.
  • Severe infection affecting the entire body (sepsis)
  • Death

No one knows what causes NEC. This means that it’s hard to prevent
it. If prematurity could be prevented, that would prevent virtually all NEC. Studies
show that premature babies whose mothers were given corticosteroid medicines before
delivery are less likely to get NEC. They also show that premature babies who are
only their own mother’s milk are less likely to get this condition. If mom’s own milk
not available, donor human milk from a milk bank is safer than formula. Starting to
a premature baby with a very small amount of milk and slowly increasing this may also

  • NEC is a serious illness in very sick,
    often premature newborns. It happens when tissue in the large intestine (colon) gets
  • No one knows what causes NEC.
    High-risk babies, especially premature babies who are fed formula instead of human
    milk, are more likely to get it.
  • Symptoms often show up in the first
    few weeks of your baby’s life (while the baby is in the hospital).
  • Your child’s healthcare provider may
    do an abdominal X-ray to diagnose them.
  • Treatment will depend on your child’s symptoms, age, and general health. It will also
    depend on how severe the condition is.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
    or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child.
    Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose
    for that visit.
  • Know how you can contact your child’s provider after office hours. This is important
    if your child becomes ill and you have questions or need advice.