Necrotizing Enterocolitis (NEC) Treatment Guidelines

Necrotizing enterocolitis (NEC) is a gastrointestinal disease that is typically seen in premature babies, although it can sometimes occur in infants born at term as well. The disease can cause damage to or death of the cells in the baby’s intestine. In severe cases, it may also cause a hole in the baby’s intestine. 

Doctors aren’t sure exactly why NEC affects some babies and not others, but it is often the result of inflammation and infection in the intestines. Necrotizing enterocolitis is seen more often in babies who drink Enfamil or Similac formula rather than breastmilk. 

Necrotizing Enterocolitis Symptoms

Usually, NEC happens within the first two weeks after birth. In some cases, it can happen up to six weeks after birth. Common symptoms of NEC in babies include:

• Abdominal swelling 
• Abdominal pain
• Changes in heart rate or blood pressure
• Bloody stool
• Poor or inefficient feeding
• Failure to gain weight 
• Green vomit
• Inability to regulate temperature
• Breathing problems
• Lethargy

Because NEC is relatively common in premature babies, the neonatal intensive care unit NICU team will be on alert for these symptoms. Often, symptoms come on suddenly. Understand, however, that many of these symptoms are common in premature babies who do not have NEC. The baby’s healthcare providers will be able to evaluate symptoms and run tests to form an accurate diagnosis. 

Diagnosing Necrotizing Enterocolitis in Babies

Of course, a baby first needs to be diagnosed with NEC before treatment can begin. To diagnose NEC, your child’s NICU team will perform a physical examination and they may examine blood and stool samples. When they suspect NEC, physicians will often order an abdominal X-ray to confirm an NEC diagnosis. An X-ray of a baby with NEC will show gas in the intestine. 

Necrotizing Enterocolitis Care Plan

The plan of care for NEC treatment typically goes one of two ways: medical treatment or surgery. For milder cases where the intestine is not perforated, most providers will try medical treatment first. Necrotizing enterocolitis immediate treatment can include:

• Stopping all traditional feeding, instead feeding through an IV catheter. This gives the intestines time to rest and heal. 
• Placing a nasogastric tube. This tube is inserted through the baby’s nose or mouth and it removes air and fluid from the stomach and intestines. 
• Administering antibiotics. Necrotizing enterocolitis antibiotic treatment is used to help fight infection. Usually, this is a broad-spectrum antibiotic. 
• Providing oxygen. Necrotizing enterocolitis oxygen therapy isn’t needed for every baby, but it may be necessary if their belly becomes very distended and makes breathing difficult. 

During necrotizing enterocolitis medical management, doctors may also routinely check stool for blood, take blood samples to check for infection, and check the baby’s belly for distension. Many babies do very well with medical management and make a full recovery. 

If medical treatment is successful, most babies can resume normal feeds within one or two weeks. When possible, breast milk is a better option over formula for babies recovering from NEC because it is more easily digested. Breast milk also boosts immunity and supports healthy bacteria. In most NICUs, donor breast milk is available for babies whose mothers are not able to provide breast milk. 

While most providers and parents prefer to hold off on surgery when possible, about 25% of babies who develop NEC will need surgery. Two situations that indicate surgery are when the intestines are perforated and if the baby is not responding to medical treatment. 

Necrotizing Enterocolitis Surgical Treatment

For some babies with NEC, surgery is necessary. With NEC surgical treatment, the surgeon will remove the parts of the intestine that are completely destroyed. They try to leave as much of the intestine intact as possible. This typically means leaving damaged areas that are able to heal. In some cases, they can sew the healthy intestines back together.

Additionally, some babies will need a temporary ostomy. This is an opening in the abdomen that allows stool to exit the baby’s body through the opening. This small hole in the baby’s belly is temporarily connected to their intestine. The ostomy will allow the baby’s intestine to heal. Usually, six to eight weeks later, a second surgery is performed to reattach the intestines. 

Some babies also need a drain placed in their abdomen to remove infected fluid. This will help their body heal from the infection and inflammation caused by NEC. 

Necrotizing Enterocolitis Newborn Care

Once a baby is recovering from NEC, the prognosis is usually good. While this can be a very scary time for parents and caregivers, most babies completely recover and do not have any long-term complications. The NICU team will continue to closely monitor your baby. They can also advise you on the best ways to care for your baby after NEC treatment as well as any future complications to be on the lookout for.