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Necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is the death of tissue in the intestine. It occurs most often in premature or sick babies.

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Infant intestines

Causes

NEC occurs when the lining of the intestinal wall dies. This problem nearly always develops in an infant who is ill or premature. It is likely to occur while the infant is still in the hospital.

The exact cause of this disorder is unknown. A drop in blood flow to the bowel can damage the tissue. Bacteria in the intestine may also add to the problem. Also, premature infants have an undeveloped immune response to factors such as bacteria or low blood flow. An imbalance in immune regulation appears to be involved in NEC.

Babies at higher risk for the condition include:

Symptoms

Symptoms may come on slowly or suddenly, and may include:

Exams and Tests

Tests may include:

Treatment

Treatment for a baby who may have NEC most often includes:

The infant will need surgery if there is a hole in the intestines or inflammation of the abdominal wall (peritonitis).

In this surgery, the doctor will:

The bowel may be reconnected after several weeks or months when the infection has healed.

Outlook (Prognosis)

Necrotizing enterocolitis is a serious disease. Up to 40% of infants with NEC die from it. Early, aggressive treatment can help improve the outcome.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Get emergency medical care if any symptoms of necrotizing enterocolitis develop. Infants who are hospitalized for illness or prematurity are at higher risk of NEC. They are watched closely for this problem before they are sent home.

Related Information

Sepsis
Intestinal obstruction and Ileus

References

Caplan M. Neonatal necrotizing enterocolitis. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 94.

Greenberg JM, Haberman B, Narendran V, Nathan AT, Schibler K. Neonatal morbidities of prenatal origin. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 73.

Seed PC. The microbiome and pediatric health. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 196.

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Review Date: 4/4/2019  

Reviewed By: Liora C. Adler, MD, Pediatric Emergency Medicine, Joe DiMaggio Children’s Hospital, Hollywood, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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