Necrotizing enterocolitis (Year of the Zebra 2024)

Summary

Necrotizing enterocolitis (NEC) is a life-threatening condition primarily affecting premature infants, characterized by inflammation and tissue death in the intestines. This condition can cause severe complications like intestinal perforation and infection. Early symptoms include feeding intolerance, abdominal swelling, vomiting, and bloody stools. Treatment involves supportive care, antibiotics, and sometimes surgery to remove damaged tissue. Although NEC has a high mortality rate, especially in extremely premature infants, survivors may face long-term complications. Prompt diagnosis and treatment are crucial for improving outcomes in affected infants.

Takeaways

• 😀 Necrotizing enterocolitis (NEC) is a rare, life-threatening condition that causes inflammation and tissue death in the intestines, commonly affecting premature infants.
• 😀 NEC typically occurs within the first two weeks of life, especially in premature babies with very low birth weights, but it can also affect full-term infants.
• 😀 Premature babies are more susceptible to NEC due to immature immune systems and gut barriers, which make it easier for harmful bacteria to invade.
• 😀 Formula-fed babies are at a higher risk of developing NEC compared to those who are breastfed, as breast milk helps promote a healthy gut flora and provides protective antibodies.
• 😀 Early symptoms of NEC include feeding intolerance, abdominal bloating, vomiting (sometimes with bile), diarrhea, and bloody stools.
• 😀 As the condition progresses, infants may experience tender or red abdominal areas, and in severe cases, a crackling sound (crepitus) may be heard due to intestinal perforation.
• 😀 NEC is diagnosed clinically through history, physical examination, and lab tests. X-rays can show dilated loops of intestine, gas in the intestinal wall, and free air in the abdominal cavity if perforation occurs.
• 😀 Treatment of NEC includes stopping oral feeding, providing intravenous fluids, administering antibiotics, and, in severe cases, surgical intervention to remove dead tissue and assess the intestines.
• 😀 Infants may require surgical procedures, such as exploratory laparotomy, and sometimes the creation of a stoma to divert stool and allow the intestine to heal.
• 😀 Despite treatment, NEC has a high mortality rate, especially in extremely premature infants, and survivors often face long-term complications, including short bowel syndrome and neurodevelopmental delays.

Q & A

What is necrotizing enterocolitis (NEC)?

Necrotizing enterocolitis (NEC) is a rare, life-threatening condition characterized by inflammation and tissue death (necrosis) in the intestines, which can lead to perforation of the intestinal wall and severe infection.

What are the main risk factors for developing NEC?

Premature birth, particularly in infants with very low birth weights, is the main risk factor for NEC. Full-term infants can also be affected. Infants fed formula rather than breast milk are at a higher risk due to the protective effects of breast milk on the gut.

How does breast milk protect against NEC?

Breast milk contains a natural balance of sugars that promote the growth of beneficial bacteria in the gut, as well as antibodies and anti-inflammatory compounds that prevent harmful microbes from adhering to the intestinal lining, thereby protecting the baby from NEC.

What are the early symptoms of NEC?

Early symptoms of NEC include feeding intolerance, abdominal bloating or swelling, vomiting (sometimes containing bile), diarrhea, and bloody stools.

What might happen as NEC progresses?

As NEC progresses, the baby's abdomen may become tender, red, or shiny. If intestinal perforation occurs, a crackling sound (crepitus) may be heard when lightly pressing on the abdomen due to free air in the abdomen.

What other signs of infection might be seen in babies with NEC?

Infants may show signs of infection such as fever, breathing problems, low blood pressure, and poor circulation.

How is NEC diagnosed?

NEC is typically diagnosed based on the baby's medical history and physical examination. Laboratory tests are used to look for signs of infection, and x-rays of the abdomen can reveal dilated loops of intestines, gas within the intestinal wall, or free air in the abdominal cavity if perforation has occurred.

Can x-ray imaging confirm the diagnosis of NEC?

X-rays can support the diagnosis of NEC, but they are not required to confirm it, as characteristic x-ray findings may not always be visible in every case.

What are the treatment options for NEC?

Treatment for NEC involves stopping oral feeding to promote intestine rest, administering intravenous fluids for hydration and nutrients, and giving antibiotics to treat infection. In severe cases, surgery may be required to remove dead tissue and potentially create a stoma for stool diversion to help the intestines heal.

What are the long-term complications for infants who survive NEC?

Infants who survive NEC may face long-term complications such as short bowel syndrome, intestinal structure issues, and neurodevelopmental delays.