Necrotizing Enterocolitis

Topic Overview

What is necrotizing enterocolitis?

Necrotizing enterocolitis is infection and inflammation of the intestine. It is most common in babies who are born early (premature). Many newborns who have it go on to live healthy lives. But if the infection becomes severe, it can cause severe damage to the intestine, which can be deadly.

This condition usually happens within the first 2 weeks after birth. But it may occur up to 3 months after birth.

See a picture of necrotizing enterocolitis.

What causes necrotizing enterocolitis?

Doctors aren't sure what causes this condition. It may occur when the immune and digestive systems do not form in the right ways. This can happen when a baby is born early or when there are problems during pregnancy or delivery.

Experts don't know if feeding formula to a newborn can lead to necrotizing enterocolitis. They do know that the disease is much less common in babies who are fed breast milk.

What are the symptoms?

A newborn baby usually is healthy before he or she starts to have symptoms of necrotizing enterocolitis. Symptoms depend on how severe the problem is. Symptoms may include:

  • A swollen, tender, red, or shiny belly.
  • Constipation.
  • Dark, black, or bloody stools.
  • Low or unstable body temperature.
  • Chills and fever.
  • Fast heartbeat and breathing.
  • Not wanting to eat.
  • Throwing up (vomiting).
  • Being less active or having little energy.

How is necrotizing enterocolitis diagnosed?

The doctor will ask about your baby’s symptoms and past health. The doctor may do tests, such as:

  • An X-ray of your newborn’s belly.
  • A test to check for blood in your baby’s stool (fecal occult blood test).
  • Tests to check for bacteria in the stool, blood, urine, or spinal fluid.

How is it treated?

Your baby will be treated in a hospital neonatal intensive care unit (NICU). Treatment usually lasts 3 to 10 days. It may last longer if the condition is severe. Treatment includes intravenous (IV) feeding, antibiotics, and a tube that goes in the nose to the stomach to remove extra fluids and gas from the intestine.

If your baby does not get better with treatment or gets a hole in the intestine, he or she may need surgery to remove the damaged parts of the intestine. Up to half of babies who have necrotizing enterocolitis need surgery.1 Many babies who have surgery for this condition go on to live healthy lives.

After treatment, your baby will be ready to leave the hospital when he or she is eating well and is not losing weight. The nurse can show you how to feed and care for your baby at home.

It is normal to feel overwhelmed by having a baby with health problems. It can be stressful to watch a tiny newborn get medical treatment. You may feel frustrated if you can't hold your baby as often as you want or can't breast-feed your baby. It may help to talk about your feelings and concerns with a social worker or counselor. Be sure to ask your baby’s doctors about anything you don't understand.

Frequently Asked Questions

Learning about necrotizing enterocolitis:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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  Bowel disease: Caring for your ostomy

Symptoms

Often, a newborn baby is feeding well, healthy, and growing before there are any signs of necrotizing enterocolitis. Typically, a doctor or nurse will notice signs and symptoms of the disease 4 to 10 days after your newborn begins milk feeding. (Sometimes a premature newborn is first fed through a tube.) But symptoms may appear as soon as 4 hours or as late as 3 months after birth.

If your newborn has mild or moderate necrotizing enterocolitis, he or she may:

  • Have a swollen, tender, red or shiny belly, with a firm loop of bowel in the intestines that your doctor can feel.
  • Not want to eat, or may be throwing up (often greenish or greenish yellow vomit), which can lead to dehydration.
  • Have a change in bowel movements. This includes:
    • Dark, black, or bloody stools.
    • Delayed passage of meconium in the first 24 to 48 hours after birth.
    • Fewer bowel movements than expected, or diarrhea.
  • Be short of breath or stop breathing for longer than 10 seconds.
  • Have a low or unstable body temperature.
  • Not be very active, or may have little energy.
  • Have few or no bowel sounds—the normal gurgling, rumbling, or growling noises in the stomach. If your baby does not have these noises, it can mean that his or her digestive system is not working well.

Less than half of the time, a newborn will have more serious symptoms that indicate severe necrotizing enterocolitis and may require surgery. These symptoms include:

  • Infection in the belly area (peritonitis). Your baby may have a swollen, hard belly; severe belly pain and tenderness; nausea and vomiting; a fast heartbeat; chills and fever; and rapid breathing.
  • Bleeding in the intestines.
  • Tissue death (necrosis) in part of the intestines.
  • Infection in the blood (sepsis).
  • Difficulty clotting blood (disseminated intravascular coagulation, or DIC). DIC often damages every organ in the body.
  • Heart or lung failure.
  • Shock .
Necrotizing enterocolitis may be mistaken for other conditions with similar symptoms.

Exams and Tests

A diagnosis of necrotizing enterocolitis is based on your baby's medical history, symptoms, and:

  • An abdominal X-ray, to provide a picture of the intestines. If your child has necrotizing enterocolitis, the X-ray may show a sausage-shaped intestine, often with air in the walls of the intestines.
  • A fecal occult blood test, to check for blood in your baby's stool.
  • A stool culture, to examine your baby's stool and to look for a specific kind of bacteria.
  • A spinal fluid test, to find out the amount of blood cells, protein, glucose, and bacteria in the fluid around your baby's spinal cord.
  • A blood culture, to identify any bacteria in your baby's blood.
  • A urine test, to look for any signs of infection or bacteria in your baby's urine.

Monitoring necrotizing enterocolitis

After diagnosis, your baby may need to have more tests to monitor the disease, including:

  • Abdominal X-rays. An abdominal X-ray can show whether the infection is improving or getting worse. X-rays are repeated every 6 to 8 hours.
  • A paracentesis. If X-ray results are not clear, your doctor may take a sample of fluid from your baby's belly. If some of the contents of the intestines are found in this fluid, it means there is a hole in your baby's intestines.
  • An abdominal ultrasound. This imaging test may be used to see if your baby's intestine is infected and inflamed.
  • An arterial blood gas test. This test can tell whether your baby has enough oxygen in his or her blood.
  • A complete blood count (CBC). This test looks at the different parts of your baby's blood to determine how well he or she can fight infection.

Treatment Overview

No matter what kind of treatment your newborn needs for necrotizing enterocolitis, it can be stressful to watch a fragile newborn undergo medical treatment. You may find that you feel overwhelmed by having a new baby with health problems. You may feel frustrated if you cannot hold your baby as often as you want or if you cannot breast-feed your baby, but instead have to pump your milk, which is then given to your baby through a tube. It can be helpful to talk about your feelings and concerns with a social worker or counselor. It is also a good idea to get to know the team of health professionals involved in your baby's care and to ask them questions about anything you do not understand.

Newborns with necrotizing enterocolitis may be treated by many health professionals, including:

How much treatment your baby needs depends on how severely his or her intestines are damaged.

All newborns with necrotizing enterocolitis require:

  • Temporary use of a nasogastric tube, which is inserted through the nose into the stomach to remove extra fluids and gas from the intestines.
  • Daily measurement of your newborn's belly. If your baby's belly gets smaller, or he or she is able to pass stools, then the intestines are working normally again.
  • A course of antibiotics.

If your baby has mild necrotizing enterocolitis, treatment generally lasts 72 hours. If your baby has moderate necrotizing enterocolitis, treatment may continue for 7 to 10 days.

If your baby has severe necrotizing enterocolitis, treatment can last up to 21 days and may include:

  • Oxygen therapy and possible treatment with a ventilator to make sure your baby is getting enough oxygen.
  • A series of abdominal X-rays to see if the infection in the intestines is getting better or worse.
  • Blood transfusions when there is a lot of bleeding or infection.
  • Drugs such as dopamine that cause the heart to pump more blood, to increase blood pressure.

If your baby's intestines are healing, he or she may continue to get IV fluids while oral feedings are started. Most babies who have mild or moderate necrotizing enterocolitis will not have any ongoing problems with digestion, nutrition, and growth.

Surgery

If your baby has severe necrotizing enterocolitis and has a hole in the intestines, seriously damaged intestinal tissue, or bowel obstruction, he or she may need surgery. If surgery is required, it has two steps:

  • In the first surgery, the upper part of the intestine is brought to the surface of the belly and a colostomy or ileostomy is created. The lower part of the intestine then does not have to digest food, which allows it to heal. Also, severely damaged sections of the intestine are removed.
  • The second surgery is performed weeks or months later, after the damaged intestine has healed. This surgery involves:
    • Closing the colostomy or ileostomy.
    • Surgically reconnecting a healthy upper section of the intestine to a healthy lower section (end-to-end anastomosis). This surgery allows body waste to pass normally through the intestines and leave the body through the rectum.

For several days after each surgery, your baby will be fed intravenously.

If your baby has only a small area of damaged tissue, some surgeons will do one surgery to remove the affected tissue and reconnect the intestines.

Complications

If your baby has surgery, he or she may develop a blockage of the intestine (stricture) up to 8 weeks after surgery. The symptoms of a blockage are the same as the symptoms of necrotizing enterocolitis. An X-ray can show where the blockage is and help your doctor know what kind of treatment is needed.

Some newborns who have necrotizing enterocolitis later develop short bowel syndrome (short gut syndrome). Children with short bowel syndrome may not grow as tall, weigh as much, or develop as fast as other children their age because they cannot absorb enough calories from the food they eat. Infants with severe short bowel syndrome may need IV feeding for weeks or months. With training and support for caregivers, IV feeding may be done at home rather than at a hospital.

Treatment is less likely to succeed in infants with a very low birth weight.2 Children who had necrotizing enterocolitis may continue to have ongoing problems with digestion, growth, and development.

Home Treatment

After being treated for necrotizing enterocolitis, your newborn can leave the hospital when he or she has been feeding well enough to stay at the same weight or gain weight. Before you take your baby home, be sure you know:

  • How much and what to feed your baby so that his or her intestines heal and grow normally. Most newborns can be fed regular formula or breast milk. But if your newborn had surgery, he or she may need to eat a special formula.
  • How to care for your newborn's colostomy or ileostomy. For more information, see:
    Click here to view an Actionset.Bowel disease: Caring for your ostomy.
  • The symptoms of an intestinal blockage, such as throwing up, a swollen belly, or any change in bowel movements. Contact your doctor immediately if your newborn has any of these symptoms.
  • How to care for your newborn's incision.
  • How often you need follow-up visits with your doctor.

If you think that you will need help caring for your newborn, talk to your doctor about contacting a pediatric home health agency. A home health agency can provide medical care for your baby in your home.

Other Places To Get Help

Organization

KidsHealth for Parents, Children, and Teens
10140 Centurion Parkway North
Jacksonville, FL  32256
Phone: (904) 697-4100
Fax: (904) 697-4125
Web Address: www.kidshealth.org
 

This Web site is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly e-mails about your area of interest.


Related Information

References

Citations

  1. Berseth CL, Poenaru D (2005). Necrotizing enterocolitis and short bowel syndrome. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., pp. 1123–1133. Philadelphia: Elsevier Saunders.
  2. Piazza AJ, Stoll BJ (2007). Digestive system disorders. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 753–756. Philadelphia: Saunders Elsevier.

Other Works Consulted

  • Brown RE, Neu J (2006). Necrotizing enterocolitis. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 293–296. Philadelphia: Saunders Elsevier.
  • Cincinnati Children's Hospital Medical Center (2007). Evidence-based care guidelines for necrotizing enterocolitis (NEC) among very low-birth-weight infants. Available online: http://www.cincinnatichildrens.org/assets/0/78/1067/2709/2777/2793/7585a353-7c3e-400f-98a6-91c6b63232fc.pdf.
  • Pietz J, et al. (2006). Prevention of necrotizing enterocolitis in preterm infants: A 20-year experience. Pediatrics, 119(1): e164–e170.

Credits

Author Maria G. Essig, MS, ELS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Jennifer Merchant, MD - Neonatal-Perinatal Medicine
Last Updated May 5, 2009

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