Digestive and Gastrointestinal Conditions

Necrotizing Enterocolitis

What Is Necrotizing Enterocolitis?

Necrotizing enterocolitis (NEC) is a problem with the intestines. "Enterocolitis" (pronounced ent-air-oh-co-LITE-iss) means inflamed small intestine and colon. "Necrotizing" (pronounced nek-roh-TIE-zing) means it causes tissue death. With NEC the intestines get irritated and infected by bacteria. The infection can cause part of the intestine to die.

In babies born early (prematurely), NEC most often affects the last part of the small intestine (ileum) or the large intestine (colon). NEC may affect just one segment of intestine or more than one segment. In the worst cases, it affects the whole intestine.

Necrotizing Enterocolitis in Children

Premature babies are more likely to get NEC. It can happen in babies who are not born early (carried to term), but this is rare. Some infants with other health problems, such as gastroschisis , may also get NEC.

The cause of NEC is not clear. Each of these factors seems to play a role:

 

  • The baby's intestines may not be mature enough to move food along well when the baby is fed. This may cause their intestines to get irritated and swollen (inflamed). Some studies show that NEC happens mostly in premature babies who have been fed (rather than getting nutrition by IV, or intravenous, line). Other studies suggest that early feeding of premature infants may actually protect against problems like NEC. The studies are controversial. There is good evidence to support both early feeding of premature babies and using only IV nutrition.
  • Bacteria in the baby's intestines reproduce. The baby's immune system is not able to protect the intestines from the bacteria. The intestines get infected.
  • The baby's immune system overreacts to the infection. The intestines get more inflamed. Blisters may form inside the intestines.
  • Blood flow to the baby's intestines is poor. The bacteria may cause this. Without good blood flow, the tissue can be damaged and die. Dead tissue may get holes (perforate). Then stool (feces) and bacteria can leak from the intestines into the belly and cause infection there (peritonitis).

 

NEC can range from mild (if no intestine dies or perforates) to life threatening. In milder cases, the intestines may heal and be fine if the baby gets medical treatment, including antibiotics to fight the infection. In more serious cases, the baby may need surgery to remove damaged intestine, or the infection may overwhelm the baby's body.

Necrotizing Enterocolitis at Seattle Children's

We have treated hundreds of babies with NEC at Seattle Children's. We generally see more than 20 babies each year who need surgery for the problem and many more who do not need surgery. Most babies with NEC (about 70%) can be treated without surgery.

Our goal is to treat this condition without surgery whenever we can. When other treatments are not enough, some babies do need surgery. Our surgeons are experienced at doing the surgeries these babies need to remove damaged intestine while leaving as much intestine as possible.

When you come to Seattle Children's, you have a team of people to care for your child. Along with your child's surgeon and neonatologist (a doctor who specializes in newborns), you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child's health needs and help your family through this experience.

Since 1907, Seattle Children's has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.