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NECROTIZING ENTEROCOLITIS(NEC)
This page is done in memory of Our Triplet Angel Kelsey who died from
complications of NEC. You can view her page and read our triplets story by
clicking the link at the end of this page.
All information on this page was compiled from a variety of resources and
articles on NEC.
*^*WHAT IS NEC?*^*
In Necrotizing Enterocolitis (NEC), the lining of the intestinal wall dies and the tissue sloughs off. The cause for this disorder is unknown, but it is thought that a decreased blood flow to the bowel keeps the bowel from producing the normal protective mucous. Bacteria in the intestine may also be a causative factor.
*^*EPIDEMIOLOGY*^*
Although 10% of all cases of NEC occur in TERM infants, it is more commonly
seen in PRE-TERM infants. The incidence appears to be similar among male
and female infants, but it is more common among black infants.
NEC is 10 times more common among infants who have been fed compared to those
who have not received enteral nutrition, and it occurs more commonly among
infants fed formula compared to those fed breast milk. NEC, however, does
occur among infants who have never been fed and who have received breast
milk feedings.
*^*IS NEC SERIOUS?*^*
YES, babies can lose some of their bowel from it. Some babies die of NEC.
For this reason doctors may start treatment on simply the suspicion that
your baby might be developing symptoms of NEC. This suspicion is sometimes
referred to as "rule out NEC", "possible NEC" or a "NEC scare."
*~*NEC is a serious disease with a death rate of over 30%. The outcome is
improved by AGGRESSIVE, EARLY TREATMENT.*~*
*^*POSSIBLE RISK FACTORS*^*
~*~Small, premature infants
~*~Outbreaks among other infants in a nursery (suggesting an infectious
cause)
~*~The feeding of concentrated formulas
~*~Infants who have received blood exchange transfusions
~*~Low blood pressure or low blood volume
~*~Asphyxia (too little oxygen reaching the tissues) and/or hypoxia (lack
of oxygen in the blood or body tissues.)
~*~Cold stress
~*~Patent ductus arteriosus (when the vessel that leads from the pulmonary
artery to the aorta does not close.)
~*~Polycythemia (an excess of red blood cells)
*^*SIGNS AND SYMPTOMS*^*
~*~General signs of being "sick": less active, more apnea(temporary cessation
of breathing), increased respiratory problems, difficulty keeping his/her
body temperature normal.
~*~Poor tolerance to feedings, vomiting or not putting through the milk placed
in the stomach (called aspirates or residuals). These may be greenish in
color.
~*~Abdominal distention or increased size of the tummy.
~*~Redness or an abnormal color to the tummy.
~*~Blood in the stool (visible or microscopic)
~*~Diarrhea
*^*WHAT CAN BE DONE FOR NEC?*^*
If NEC is suspected, any or all of the following might be done.
~*~All regular feedings will be stopped. The baby will have an IV started
so s/he can be fed by vein. This could go on for weeks to let the bowel
heal.
~*~A tube placed into the stomach either from the mouth or nose. The tube
removes air and fluids from the baby's stomach and intestines.
~*~The tummy size will be measured with a tape measure and watched
carefully.
~*~X-rays of the tummy (may be done every 8-12 hours to check for rupture
of the bowel wall.)
~*~Antibiotics will be started in case of an infection.
~*~A sample of the blood will be sent to the laboratory to see if it contains
bacteria.
~*~More frequent blood tests to look for signs of infection.
~*~The baby may require supplemental oxygen or ventilation because of apnea
and shock.
*^*TREATMENT OF NEC*^*
If intestinal perforation (hole) or peritonitis (inflammation of the abdominal wall) develop, SURGERY is indicated. If only the innermost lining of the bowel dies, the body can slowly regrow it. It the entire thickness of a piece of bowel dies, then that part of the bowel must be removed. The end of the bowel above the removed segment may be brought to the surface of the skin (called an ostomy). At some later time, after the baby has recovered and grown much bigger, the two ends of the bowel can be sewn back together again.
*^*POTENTIAL COMPLICATIONS/PROBLEMS*^*
Approximately 75% of infants who develop NEC survive. Most babies who
recover from NEC do not have further problems; but future problems are possible.
These include:
~*~scarring and narrowing of the bowel causing an obstruction or blockage
of the bowel. These complications may require surgery later on.
~*~Malabsorption or inability of the bowel to absorb nutrients normally.
~*~Infants with NEC may also develop signs of shock or problems with blood
clotting.
~*~If the disease is extensive, the amount of healthy bowel remaining may
be quite short and unable to absorb enough nutrients and water from the stool.
This is called "Short Bowel Syndrome," or "Short Gut." Babies with short
gut require intravenous nutrition (TPN) for a prolonged period of time. They
also need special formula and nutrient supplements.
I have not found a lot of information about NEC as it is still a mystery as to the cause. I hope this site has helped a little. The March of Dimes currently has three research studies going on right now about NEC.
