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Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most common and lethal surgical abdominal emergency in the newborn. The cause of NEC is unclear. Risk factors include prematurity (++++), hypoxic ischemic insults, aggressive enteral feedings, and a history of infection. In the past 20 years improvements in neonatal intensive care have allowed increased survival in premature infants, and the incidence of NEC has increased concurrently. This disease is seen almost exclusively in the neonatal intensive care unit, although as more infants are sent home earlier in life, NEC presentations to the ED may increase. Extremely premature infants (<28 weeks) remain at high risk until they reach the postconceptual age of 35 to 36 weeks.

Causes

In necrotizing enterocolitis, the lining of the intestinal wall dies and the tissue sloughs off. The cause for this disorder is unknown, but it is thought that a decreased blood flow to the bowel keeps the bowel from producing the normal protective mucus. Bacteria in the intestine may also be a cause.

At risk are small, premature infants, infants who are fed concentrated formulas, infants in a nursery where an outbreak has occured and infants who have received blood exchange transfusions.

Symptoms

Vomiting and poor feeding ++
Lethargy
Irritability
Episodes of apnea

Signs

Abdominal distention ++++, may evolve over time
Blood in the stools, gross or occult ++++
Fever is uncommon.
Red streaks on the abdomen are occasionally seen in advanced cases.

Treatment

The majority of infants with Necrotizing Enterocolitis are treated medically, and symptoms resolve without the need for surgery. Treatment includes:

Stopping feedings
Nasogastric drainage
Intravenous fluids for fluid replacement and nutrition
Antibiotics for infection
Frequent examinations and X-rays of the abdomen

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