No Guts all Glory!

Gastroschisis / NEC / Short Bowel Syndrome / Omegaven


What is Necrotizing Enterocolitis (NEC)?

How common is it?

NEC occurs in only one in 2,000 to 4,000 births, or between 1% and 5% of neonatal intensive care unit (NICU) admissions, however NEC is the most common and serious gastrointestinal disorder among hospitalized preterm infants.

What causes NEC?

Premature infants have immature bowels, which are sensitive to changes in blood flow and prone to infection. The real cause though is still unknown.  It is similar to gastroschisis in that there are many unproven theories about the causes of NEC. 

Some of the more common ones are that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow, and when feedings are started, the added stress of food moving through the intestine allows bacteria that are normally found in the intestine to invade and damage the wall of the intestinal tissues. The damage may affect only a short segment of the intestine, or it may progress quickly to involve a much larger portion.

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.

NEC sometimes seems to occur in "epidemics," affecting several infants in the same nursery. Although this may be due to coincidence, it suggests the possibility that it could in some cases be spread from one baby to another, despite the fact that all nurseries have very strict precautions to prevent the spread of infection.

What are signs of NEC?

NEC is an infection and inflammation that causes destruction of the bowel (intestine) or part of the bowel.

The scary part about the symptoms of NEC is that they may resemble other digestive conditions. Every infant experiences the symptoms of NEC differently, which may include:

  1. poor tolerance to feedings

  2. feedings stay in stomach longer than expected (called residuals)

  3. decreased bowel sounds

  4. abdominal distention (bloating) and tenderness

  5. greenish (bile-colored) vomit

  6. redness of the abdomen

  7. increase in stools, or lack of stools

  8. bloody stools

More subtle signs of NEC might include apnea (periodic stoppage of breathing), bradycardia (slowed heart rate), diarrhea, lethargy, and fluctuating body temperature, fussiness, mostly I hear it described that the baby just starts acting “funny” and not like themselves. Advanced cases may show fluid in the peritoneal (abdominal) cavity, peritonitis (infection of the membrane lining the abdomen), or shock.

A baby with NEC will first be evaluated to see if emergency surgery is needed. Treatment may consist of:

  1. Medical treatment. Feedings are stopped to rest the bowel. The baby is             

  2. fed with TPN. Antibiotics are used to prevent infection and further damage. If the baby doesn’t begin to get better within a couple of days, surgery may be the next step.

  3. Surgery to remove part of the bowel. The necrotic portion of the bowel is removed. This protects the remaining bowel and allows it to heal.

  4. An ostomy. In some cases, the best way to let a portion of the bowel heal is to reroute the stool. If so, the surgeon will create a stoma. This is done by bringing the open ends of the bowel through an incision in the abdomen. A stoma keeps waste from traveling through the part of the bowel that needs to rest. After the bowel has healed, the ends are then reconnected, and the ostomy is closed.

How is NEC treated?

Necrotizing Enterocolitis