Neonatal Necrotizing Enterocolitis

Neonatal necrotizing enterocolitis is intestinal damage occurring in premature infants, resulting in the death or necrosis of parts of the intestine.

  • Bloody stools, distension of the abdomen, and sluggishness in the infant, are the usual symptoms. Vomiting of a yellowish, rust- colored, or greenish fluid may be present.
  • An x-ray of the abdomen helps confirm the condition.
  • As part of treatment, feeding is completely stopped and the abdomen is emptied. A suction tube is introduced to reduce pressure in the stomach. Intravenous administration of fluids and antibiotics are started.
  • The portions of the intestine which have become damaged due to lack of blood supply are surgically removed. In case surgery is not possible due to the infant’s unstable condition, the abdominal cavity is drained with a tube.
  • The rate of survival of infants with necrotizing enterocolitis is around 60 to 80%.

Neonatal Necrotizing enterocolitis (NEC) is primarily a condition affecting infants born prematurely, with low birth weight pre-term infants accounting for almost 85% of the cases. The exact cause of this condition is not known, even though immature blood circulation is thought to be the underlying reason. Limited blood supply to the intestinal tissues due to immature capillary growth may result in the damage of the inner walls of intestines. Bacteria abundant in the gastrointestinal tract may cause infections in the damaged wall of the intestine. When the whole thickness of the wall of the intestine is infected, it may develop perforations on the wall. The stool and other contents of the intestine leaking into the peritoneal cavity may cause peritonitis, or widespread infection and inflammation of the peritoneal membrane as well as other tissues and organs in the abdomen. When the infection enters the blood, it causes sepsis.

Symptoms and Diagnosis

Abdominal distension, or swelling up of the abdomen, is one of the first symptoms to appear. Bloody stools are another indication. Infants with NEC may vomit a greenish yellow or rust- colored fluid. Infants become sluggish and look extremely sick. Frequent disruptions in breathing called apnea and low temperature are other signs.

An x-ray of the abdomen may show a condition called pneumatosis intestinalis characterized by gas collection in wall of the intestine. If there are perforations in the intestinal wall, the presence of free air may be seen in the peritoneal cavity. A blood test may detect bacterial infections or sepsis, if present.

Prognosis

With emergency medical treatment with appropriate drugs, and surgery, the prognosis of premature infants with necrotizing enterocolitis has improved considerably. Survival rates between 60%-80% have been achieved.

Prevention and Treatment

When extremely premature babies are fed expressed milk from their mother, the incidence of necrotizing enterocolitis has been found to be much lower than it is in infants fed formula milk. The protective effect of the mother’s milk can be utilized to prevent the disease by introducing small amounts of it as soon as possible after birth.

When neonatal necrotizing enterocolitis is detected, gastrointestinal nutrition is stopped completely. The pressure in the intestine is relieved by introducing a suction tube into the stomach. Antibiotic therapy is started immediately and fluids as well as drugs are given intravenously.

Majority of infants with necrotizing enterocolitis do not require surgery. But in around 30% of cases, surgery is necessitated by intestinal perforations which leak intestinal matter into the peritoneal cavity, resulting in peritonitis. When the disease progresses without responding to other treatments too, surgery may be the only option. The portions of the intestine which have become irreparably damaged, or which contain dead tissue, are removed. The remaining intestine is rerouted to an opening created on the abdominal wall through which stool is eliminated. This is a temporary measure, and the cut ends of the intestine are reconnected later, once the infant overcomes the disease.

Many infants, particularly the smaller and sicker among the premature infants, may not be strong enough to withstand an abdominal surgery. In such cases, the abdominal cavity is drained by introducing peritoneal drains into the lower part of the abdomen on both sides. The intestinal content leaking into the peritoneal cavity as well as the peritoneal fluid is drained out through these tubes. When combined with antibiotic treatment, this procedure often helps reduce symptoms and stabilizes the infants till they are ready to undergo a major abdominal surgery. Some infants may even get better with this procedure alone, and may not require surgical intervention.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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