Necrotizing enterocolitis (NEC) is a serious illness in babies. Here I would like to clear you that each word in necrotizing encrocolitis has proper meaning like "necrotizing" means damage and death of cells, "entero" refers to the intestine and "colitis" means inflammation of the colon (lower part of the intestine). Although it affects only one in 2,000 to 4,000 births, or between 1% and 5% of neonatal intensive care unit (NICU) admissions, NEC is the most common and serious gastrointestinal disorder among hospitalized preterm infants.



Causes

No single factor has been established as the cause of NEC. Medical researcher believes that NEC is the result of a combination of several factors. The two consistent findings are prematurity and feedings. The premature intestine reacts abnormally and develops an acute inflammatory response to feedings leading to intestinal necrosis (death). Some postnatal issues including heart abnormalities, obstruction of circulation in the bowel, infection or gastroschisis are also cause of NEC.

Some experts believe that the makeup of infant formula, the rate of delivery of the formula, or the immaturity of the mucous membranes in the intestines can cause NEC. Babies who are fed breast milk can also develop NEC, but their risk is lower. Another theory is that babies who have had difficult deliveries with lowered oxygen levels can develop NEC. When there is not enough oxygen, the body sends the available oxygen and blood to vital organs instead of the gastrointestinal tract, and NEC can result.

Symptoms

Initial symptoms vary and may include-

Feeding intolerance

Abdominal distension

Bloody stools

Apnea

Lethargy

Poor feeding

Temperature instability or hypoperfusion.

The speed of progression of the disease is quite variable. In some cases, the onset is sudden with little (if any) warning signs and is followed by a rapid clinical deterioration, such as severe apnea requiring intubation, persistent metabolic acidosis, decreased peripheral perfusion and hypotension requiring boluses of intravascular fluid and pressor therapy.

Treatment

In an infant suspected of having necrotizing enterocolitis, feedings are stopped and gas is relieved from the bowel by inserting a small tube into the stomach. Intravenous fluid replaces formula or breast milk. Antibiotic therapy is started. The infant's condition is monitored with abdominal x-rays, blood tests, and blood gases.If medical management fails or if the bowel is perforated, surgery becomes necessary.

After opening the abdomen, the pediatric surgeon may find a swollen, discolored bowel with several areas that have died due to a lack of blood supply, or the entire bowel may be involved. The aim of surgery is to remove only the bowel that has died and to leave any segments of the bowel that hopefully will recover. In some cases, a drain is placed in the abdomen to remove the infected fluid.