Necrotising enterocolitis (NEC)

Bacteria invades the wall of the baby’s delicate intestinal tissue, causing inflammation and tissue damage to set in. Unchecked, the inflammation creates a hole or gap which allows the contents of the intestine to leak into the baby’s abdomen and cause overwhelming bacterial infection (sepsis), and sometimes multi-organ failure and death.

• Necrotising enterocolitis (NEC) is one of the most common cause of surgical emergency and death in premature babies between days 15 and 60 of life.
• Up to a third (between 20-30 per cent) of babies who develop NEC die – a number that has changed little over the past 50 years.

NEC is more common in premature infants, but also in very sick babies that are born with a heart disease. Babies at risk include those who are

• Born before 32 weeks
• Weigh less 1,500 grams
• Fed through a tube in the stomach
• Fed formula, by mouth or tube
• Have had a difficult delivery
• Have lowered oxygen levels
• Have too many red blood cellsin circulation
• Gastrointestinal infections.

Full-term but who other health problems, like a heart defect.

The cause NEC is not yet known. The contributing factors include babies who have

• Weaker immune systems
• Underdeveloped intestines and lungs
• Difficulties moving oxygen carrying blood around their body, including to immature intestinal tissues
• Difficulties breaking down food – formula fed babies are at a higher risk of NEC than breast fed babies
• Dysbiosis of the gut – decreased beneficial microbiota and increased pathogenic bacteria in the gut
• Infection.

NEC sometimes affects several infants who are in the same area. While NEC does not spread between babies, a virus or bacteria that causes it can. As a result, hospitals have strict precautions to help prevent the spread of infections.

NEC can progress very quickly. Getting immediate treatment is vital to stop the condition taking hold. Symptoms include general signs like

• Trouble feeding
• Swollen, red or tender stomach
• Vomiting bile (green)
• Bloody stools as a result of infection in the bowel wall.

If these signs are not acted on, the following may develop

• Trouble breathing
• Unstable body temperature
• Slow heart rate
• Red, swollen or tender abdomen
• Diarrhea
• Lethargy, less active
• Shock (decreased blood pressure).

NEC is difficult to diagnose, tests used include

• X-rays – to show gas or air bubbles in the intestinal wall, indicating a damaged bowel
• Blood – to check for bacteria and infection. A low white blood counts shows that the baby’s ability to fight infection is reduced
• Faecal – to check for blood that may not be visible
• Insertion of needle into the abdomen – the presence of fluid is a sign there’s a hole in the intestine.

Current treatment is offers basic support to rest the intestines by using intravenous fluids to keep the baby nourished and hydrated and antibiotics to fight infection. This includes the insertion of a tube through the nose into the stomach to remove fluid and keep the stomach empty.

Other supports include extra oxygen or a ventilator if the stomach is too swollen for breathing, and regular X-rays are used to monitor the condition.

If the baby does not respond, and a hole develops, surgery is needed to remove injured and dead intestine.  Some infants who have surgery may not be able to absorb nutrients normally and may need a bowel transplant to live. Sadly, there is high fatality rate.