Necrotizing enterocolitis (NEC) is a devastating disease that affects the intestine of premature infants. The wall of the intestine is invaded by bacteria, which causes local infection and inflammation that can ultimately destroy the wall of the bowel. This can lead to perforation or rupture of the intestine and spillage of stool into the infant’s abdomen, which can result in an overwhelming infection (sepsis) and death.
Unfortunately, its cause is completely unknown and multifactorial. It is the most common serious surgical disorder among infants in the NICU and is a significant cause of neonatal morbidity & mortality.
Overall, NEC affects between 1-5% of NICU admissions and occurs in nearly 10% of preemies. It affects 1 out of every 2,000-4,000 births. The premature infant has immature lungs and immature intestines. Therefore, any decrease in oxygen delivery to the intestines—because the lungs cannot oxygenate the blood adequately—will damage the lining of the intestinal wall.
One of the first signs of NEC is feeding intolerance. This is often associated with abdominal distention (bloating), discolored belly, bowel loops, bloody stools, and vomiting bile (green). Other clinical manifestations include lethargy, apnea/bradycardia spells, hypotension, & temp instability. The diagnosis of NEC is usually confirmed by the presence of gas or air bubbles in the wall of the intestine on an abdominal X-ray. Dilated bowel and pneumatosis may also be visible. It is most commonly found in infants who are fed formula versus breastmilk.
Initial treatment of NEC consists of:
Discontinue the feedings and place patient NPO
Insert an OG tube or NG tube to suction to decompress stomach
Administer IV fluids for hydration
Antibiotics
Perform frequent, serial X-rays of the abdomen
Infants who respond to this treatment often can resume feeds when signs of the infection have disappeared. This may take one to two weeks. Infants who have more severe disease may require a longer period for the return of bowel function. Infants who do not respond to medical treatment and develop worsening condition or bowel perforation will require surgery.
How is the surgery performed?
At the time of surgery, the surgeon may find portions of the intestine that is frankly necrotic (dead) or perforated. The operation consists of removing the piece of ruptured intestine, and the surgeon tries very hard to preserve as much intestine as possible by removing only the segments absolutely necessary.
Prognosis:
Most infants who develop NEC recover fully and do not have further problems/complications. A potential residual problem may be malabsorption; there are some infants who lose so much intestine from the infection that they do not have enough intestine left to survive (AKA “short gut”).
Treatment/Prevention:
This includes the administration of probiotic bacteria (lactobacillus) to counteract the effects of the pathogenic bacteria that cause the infection.
Referenced from: https://www.chla.org/necrotizing-enterocolitis