What is it

What causes it

What are the symptoms

How is it treated

What are the long-term problems

What can a parent do

Necrotizing Enterocolitis or NEC is an inflammation of the small or large intestine (bowel).  NEC may involve only the inner most lining of the intestine or the entire thickness of the bowel.  It may affect a little or a lot of the bowel.

NEC can be serious; babies can lose some of their bowel from NEC.  Therefore, if the doctor “thinks” or suspects your baby is developing NEC treatment is started.

Premature babies have immature and fragile intestines.  Their intestines are sensitive to changes in blood flow, oxygen and to infection.  When these changes happen the baby is at risk of developing NEC.

We often do not know which baby will develop NEC or why a specific baby does develop NEC. 

NEC usually occurs when babies are 3-12 days old but a baby may develop NEC when they are several weeks old.

It usually begins a few days after feedings are started; however, babies fed breast milk get NEC less often.

Symptoms vary from mild to severe.

The most common symptoms are:

	Apnea
	Unstable temperature  (high & low)
	Lethargy (less active)
	Increasing oxygen needs
	Abdominal swelling (increased size of tummy)
	Residuals (undigested feeding still in the baby’s tummy from last feeding)
	Vomiting
	Blood in the stool

If the doctor “thinks” your baby is developing NEC, any or all of the following may be done.

Stop all feedings.  The nurse will tell you the baby is NPO.  This may last for approximately 14 days.

Start an IV to give the baby feedings and medications.

Place a tube through the baby’s mouth down into their stomach.  The tube may or may not be connected to suction.  The tube removes air and fluid that collects in the baby’s stomach and intestine.

Obtain x-rays of the stomach and intestines.  The x-rays may be repeated to see how the baby is doing.

Draw blood for lab tests to check for bacteria and imbalances.  These tests may also be repeated to see how the baby is doing.

Start antibiotics. 

Test the baby’s stool for blood.

Measure the baby’s abdomen with a tape measure and watch it closely.

Start or increase the baby’s oxygen.  The baby may also need help in breathing; we will monitor the baby closely to determine what and how much help he needs.

Surgery may be necessary.  If it is necessary, the doctor will talk with you about it and what to expect. 

Most babies who recover from NEC do not have any long-term problems with their intestines. 

Future problems are a possibility if the NEC is serious.  The baby may develop:

	Scarring and narrowing of the bowel causing an obstruction (blockage)
	Malabsorption—the bowel has difficulty absorbing nutrients

The doctor will talk with you about these concerns.

This will not change your time with your baby

	Please continue to visit as usual
	If you are unable to visit every day, please call the NICU and talk with us.

An important part of the baby getting better is the parents’ love and concern.  We encourage you to talk and sing to your baby, gently touch or hold your baby when possible.  Your love and attention will go a long way in helping your little one on the road to recovery.

Talk with your baby’s nurse and doctor to keep up with the baby’s progress.