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Necrotising enterocolitis

OVERVIEW

Necrotising enterocolitis (NEC) is a condition that arises when the tissue in the lining of the small or large intestine is damaged and undergoes necrosis, resulting in inflammation of the intestine. NEC typically occurs in a premature baby, but it can occasionally occur in a full-term baby.

Typically, NEC affects only the inner lining of the intestine, although it can ultimately impact the entire thickness of the intestine. In severe cases, a hole may develop in the intestinal wall, which can cause widespread infection as the bacteria from the intestine can leak into the abdominal cavity, leading to a medical emergency.

While NEC can develop in any newborn within the first two weeks of birth, it is most commonly seen in premature infants, who make up about 90% of all NEC cases. As NEC can progress rapidly, it is crucial to seek treatment immediately if your baby shows any symptoms of this serious condition.

Signs and symptoms of necrotising enterocolitis

NEC can develop within two to six weeks after birth, depending on the type and cause of the condition. Symptoms may appear gradually over a few days or suddenly in otherwise healthy-looking babies.

NEC is a frequent issue among infants in neonatal intensive care units, and your baby's healthcare team will be vigilant for signs of this problem.

Symptoms of NEC may include the following:

Abdominal pain and swelling
Changes in heart rate
Blood pressure
Body temperature
Breathing
Diarrhoea with bloody stool
Green or yellow vomit
Lethargy
Refusal to eat
A lack of weight gain.

Treatment

Rest and healing are essential for your baby's intestines in treating NEC. The initial step is to halt tube or oral feedings and instead administer intravenous (IV) fluids and nutrients.

Additionally, your baby may receive the following treatments:

Nasogastric tube: A thin, long tube is inserted through the nose (or occasionally through the mouth) and into the stomach to remove fluids and gas by suction.
Antibiotics: These medications can help fight bacterial infections.

Approximately 1 in 4 babies with NEC require surgery to remove necrotic intestinal tissue and repair perforations. In some cases, your child's healthcare provider may perform an ostomy procedure. This involves creating a small hole or stoma in the child's abdomen and connecting the large intestine to it, allowing waste to exit the body into a bag attached outside of the body. Once the baby is healthier, the intestines will be reattached and returned to the abdominal cavity.

If your child is too small, weighing less than 1 pound, or too unwell for surgery, a catheter may be placed in the abdomen to reduce symptoms by eliminating unhealthy or infected fluids and gas. If necessary, surgery will be postponed until your baby grows bigger and is in better health.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1Who is most at risk of developing NEC?

NEC is mostly seen in premature infants, especially those with a birth weight of fewer than 1,500 grams. Infants who are fed formula instead of breast milk or who experience feeding difficulties or infections are also at risk of developing NEC.

2Can NEC be prevented?

There are some steps that can be taken to reduce the risk of NEC, such as providing breast milk instead of formula, using probiotics, practising good hygiene, and monitoring for early signs and symptoms.

3How is NEC diagnosed?

NEC is typically diagnosed through physical examination, medical history, and diagnostic imaging tests, such as abdominal X-rays and ultrasounds.