How is necrotizing enterocolitis treated?

The most common cause of gastrointestinal-related illness and death among babies in the neonatal intensive care unit (NICU), necrotizing enterocolitis (NEC) is a type of intestinal inflammation that can be life-threatening if not treated immediately.

examines a newborn baby in the Neonatal Intensive Care Unit

How can necrotizing enterocolitis be prevented?

The most definitive step toward preventing NEC is to prevent preterm birth. However, some experts believe that the following steps have been shown to reduce the risk for NEC among those who are born pre-term.

>> What is necrotizing enterocolitis?

  • Early feeding with colostrum/human milk. Because the colostrum and mother’s milk contain many protective elements, even small quantities of a baby’s mother’s colostrum or early breast milk may have some protective effect.
  • Avoiding gut starvation. Health care teams are mindful that feeding practices contribute to infant health. If an infant is very ill, they may need to withhold feedings because digestion is difficult. However, prolonged starvation is a risk factor for NEC, and therefore, early, small amounts of feeding are considered protective.
  • Some reports indicate that prophylactic use of probiotics can help prevent NEC. However, no definitive studies have been conducted in the United States on probiotic use, and thus far, probiotics are not approved for use in sick newborn infants.
What are common treatments for necrotizing enterocolitis (NEC)?
The treatment for NEC varies with the severity of the disease. Three stages (Bell stages) have been defined:
  • Stage 1, suspected NEC, includes symptoms such as bloody stools, diminished activity (lethargy), slow heart rate, an unstable temperature, mild abdominal bloating, and vomiting.
  • Stage 2, definite NEC, includes all the symptoms of stage 1 as well as slightly reduced blood platelet levels, a slight excess of lactic acid, no bowel sounds, pain when the abdomen is touched, reduced or no intestinal movement, and the growth of gas-filled spaces in the walls of the intestine.
  • Stage 3, advanced NEC, includes the symptoms of stages 1 and 2 plus periods of not breathing, low blood pressure, a lowered number of certain white blood cells, blood clot formation, a stop in urination, inflammation of tissue in the abdomen, increased pain when the abdomen is touched, redness in the abdomen, a build-up of fluid and gas in the abdominal cavity, and excess acid.
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The treatment for stage 1 patients includes vigorous supportive care, resting the intestine by feeding through an intravenous tube instead of the mouth, and continued diagnostic and monitoring tests to ensure that the disease is not progressing. Treatments for stage 2 patients include continuation of stage 1 treatments and the use of antibiotics. Emergency surgery is sometimes performed for stage 3 patients.

>> Heart rate may predict risk of necrotizing enterocolitis in premature babies

Other treatments offered at all stages of NEC include:
  • Inserting a tube through the nasal passages or mouth into the infant’s stomach to remove air and fluid
  • Taking blood samples to look for bacteria and giving antibiotic treatment through an intravenous tube
  • Measuring and monitoring the infant’s belly for swelling. If it becomes so swollen that it interferes with breathing, the infant may be given oxygen or put on a ventilator.

Many infants respond to treatment within 72 hours, and physicians may decide to put these infants back on regular feeding. (Generally, infants are not fed for up to 2 weeks or longer with confirmed NEC.) However, if the condition worsens or a hole develops in the intestine or bowel, surgery may be needed.

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