Necrotizing Enterocolitis (NEC)

On call last week, I had a patient with multiple complications of prematurity develop yet another, necrotizing enterocolitis or NEC. NEC is a disease of the intestinal tract of newborns which is seen almost exclusively in premature babies. The disease manifests as small bubbles of air which are present within the wall of the intestine which can often be seen on xray. In it's mildest form, a baby may have some intestinal dysfunction requiring discontinuation of feedings. In its most severe form it results in dead segments of bowel and sometimes death.

This baby was born at ~ 26 weeks of gestation and as mentioned, had multiple complications of his prematurity. At the beginning of the evening, he was on a respiratory support called CPAP which delivers positive airway pressure through a device placed on the nose. He was also being fed though an orogastric tube (tube place in the mouth which goes to the stomach). The first sign of a problem was that his feedings started not passing through as they should, a situation referred to as gastric residuals (a volume of feeding left in the stomach when checked through the OG tube). At this point we stopped the baby's feeds and switched him over to IV nutrition. Later he began to have an increasing oxygen requirement and frequent pauses in his breathing, a condition known as apnea. For this reason, he was placed on a ventilator. At that time, an xray was done of his abdomen which did not reveal any of the typical findings of NEC (most notably the air bubbles in the intestinal wall). However, as a precaution we did not start his feedings back, and we repeated the xray several hours later. Again there was no air seen, however, there was a segment of bowel which did not appear to be functioning properly. At this point we started antibiotics, as it is felt that NEC can be the result of an infection. The baby did not deteriorate any further, but he will be kept off of feedings for 10 days prior to trying again. At this point, there is no way of knowing if there has been any permanent damage to the intestine and only time will tell.

For more information about NEC, check out the links above, or follow this link. Many of the ads on this site also link to sites with supplemental information about topics in neonatology.
Enjoy!