In milder cases of necrotizing enterocolitis (NEC), the baby's intestines may heal if the baby gets medical treatment. In more serious cases, the baby may need surgery to remove damaged intestine.
Necrotizing Enterocolitis Treatment Options
Treatment without surgery
If there's no sign that your baby's intestine has died or has holes (perforated), your baby may not need surgery.
Your baby will need a nasogastric (NG) tube, which goes through their nose to their stomach. The NG tube will suction air out of their stomach and intestines. Your baby will keep the NG tube until all signs suggest their intestines have healed and are ready to handle feedings with formula.
Your baby will need IV (intravenous) fluids to prevent dehydration, keep their blood chemicals normal and give them nutrients. Your baby will also get IV antibiotics to fight infection. In most cases, babies with NEC need antibiotics for 10 days to two weeks. During this time, your baby will not be fed so their bowel can rest and heal. Instead your baby will get IV nutrition.
It's important to keep your baby's blood pressure normal to make sure their intestines get good blood flow. IV fluids will help with this. Some babies need medicine to help support the blood pressure.
The doctor will use X-rays and blood tests to monitor your baby's health during treatment.
Surgery for NEC
If there are signs that any segment of your baby's intestine has died or perforated, your baby will need surgery to remove that segment. The goals of surgery are to remove only the dead or perforated segment and to leave as much as possible. Even if some of the intestine that's left is inflamed or infected, it might heal. Your baby is likely to grow and develop better if they have more intestine left.
Before the surgery, the surgeon and the neonatologist (a doctor who specializes in newborns) will try to make your baby's condition stable. Your baby will need the same treatments as babies who aren't having surgery. For example, your baby will need an NG tube, IV fluids and antibiotics.
At the time of surgery, we give your baby medicine to make them sleep without pain (general anesthesia).
The surgeon makes a cut (incision), usually above the belly button, to enter the abdomen. Then the surgeon cuts on each side of any segment of bowel that is dead and takes it out.
Some of the intestine may be sick but not dead. The surgeon may leave this part because it is important for your baby to have as much intestine as possible. Then your baby may have another surgery within 24 to 48 hours to see if the intestine will survive or needs to be removed.
When surgeons have to cut out a segment of intestine, they may sew together the two open ends of the intestine (primary anastomosis, pronounced an-as-toe-MOE-sis). This may be possible if only a small segment was removed, the rest of the intestine seems healthy, and your baby is in good condition.
If a large segment was removed or the rest of the intestines do not seem healthy, the surgeon might not connect the two open ends. Instead, the surgeon creates two small openings (stoma) in your baby's belly. (This procedure is called an ostomy, pronounced OST-uh-mee). The surgeon sews the upper end of the intestine to one opening. This lets bowel movements come out of the body into a plastic pouch attached on the outside. Next, the surgeon sews the lower end of the intestine to the other opening. This end is called the mucus fistula. Usually very little comes out of the mucus fistula.
If your baby needs ostomies, you will get instructions about how to care for the openings. Later, after your baby is doing better, the surgeon will connect the two ends of the intestine and close the openings in your baby's belly Usually this is done at least two months later and when the baby is growing well.
As NEC heals, a stricture may form in the intestine. A stricture is a scar that makes the intestine very narrow. This can happen where the surgeon sewed the two ends of the intestine together. It can also happen in areas of the intestine that had NEC and didn't need surgery. Usually if a stricture forms, the baby needs surgery to fix it.
If your baby needs a large segment of intestine removed, they may be at risk for short bowel syndrome. The surgeon will keep as much intestine as possible to try to prevent this.
After surgery, your baby goes to the neonatal intensive care unit (NICU), where they get the high level of care they need. When your baby is ready, they move to a regular hospital room and eventually to home. Your baby gets the antibiotics, pain medicine and other medicines needed to help them recover.
Babies who have NEC may need to stay in the hospital for weeks or even months, whether they had surgery or not. Most often their long stay is due to other health issues linked to being born early (prematurely) rather than to NEC alone.
All babies with NEC get feedings through a tube that goes into a large vein (central line). When they have recovered from NEC, some of them will have a tube that passes through the nose or mouth into the stomach (nasogastric tube, NG tube; or orogastric tube, OG tube).
The surgery and neonatology staff will stay closely involved with your baby's care. As your baby starts to feed again, your baby will need less care from the surgeon, and neonatology will take over all of the care. The surgeon will see your baby again if the ostomies need to be closed, if there are problems with short bowel syndrome, or if there are any other issues that relate to surgery.