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A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.

A.D.A.M. Medical Encyclopedia.

Necrotizing enterocolitis

Last reviewed: May 16, 2011.

Necrotizing enterocolitis is the death of intestinal tissue. It most often affects premature or sick babies.

Causes, incidence, and risk factors

Necrotizing enterocolitis occurs when the lining of the intestinal wall dies and the tissue falls off. The cause for this disorder is unknown. However, it is thought that a decrease in blood flow to the bowel keeps the bowel from producing mucus that protects the gastrointestinal tract. Bacteria in the intestine may also be a cause.

This disorder usually develops in an infant that is already ill or premature, and most often develops while the infant is still in the hospital.

Those with a higher risk for this condition include:

  • Premature infants

  • Infants who are fed concentrated formulas

  • Infants in a nursery where an outbreak has occurred

  • Infants who have received blood exchange transfusions

Symptoms

Symptoms may come on slowly or suddenly, and may include:

Signs and tests

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.

Surgery will be needed if there is a hole in the intestines or peritonitis (inflammation of the abdominal wall). The dead bowel tissue is removed and a colostomy or ileostomy is performed. The bowel is then reconnected several weeks or months later when the infection and inflammation have healed.

Expectations (prognosis)

Necrotizing enterocolitis is a serious disease with a death rate approaching 25%. Early, aggressive treatment helps improve the outcome.

Complications

Calling your health care provider

If any symptoms of necrotizing enterocolitis develop, especially in an infant that has recently been hospitalized for illness or prematurity, go to the emergency room or call the local emergency number (such as 911).

References

  1. Piazza AJ, Stroll BJ. Digestive System Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 102.

Review Date: 5/16/2011.

Reviewed by: Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Clinical Instructor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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What works?

  • Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates
    Immunoglobulin given orally for preventing emergency intestinal problems (necrotizing enterocolitis) in premature and low birth weight newborn infants. Destructive inflammation of the intestine (necrotizing enterocolitis, NEC) is caused by gas‐producing bacteria that ferment milk. It is a potential problem for newborn preterm and low birth weight (less than 2500 grams) infants. Even after leaving hospital, affected infants may need frequent and prolonged hospitalisation because of continuing nutritional problems. This makes it difficult for parents both emotionally and financially. Immunoglobulins are proteins found in the blood that give the body immunity to disease. Immunoglobulins (types IgA and IgG) taken orally may protect susceptible infants from developing necrotizing enterocolitis. The review authors searched the medical literature and found three randomised controlled trials (with 2095 newborn infants). Treatment was started either in the first twenty‐four hours following birth (two small studies) or following commencement of oral feeding (enteral) (one large well‐controlled study). In this large study, infants generally received breast milk, whereas they received formula milk in the other two studies. Giving immunoglobulin (IgG or an IgG and IgA combination) did not reduce the incidence of NEC, need for surgery related to NEC, or death from NEC, either during or after the study period. Immunoglobulins could possibly cause breakdown of red blood cells (haemolysis), but no clinically important haemolysis was apparent. There were no other reported side effects.
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Figures

  • Infant intestines.

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