How Is Necrotizing Enterocolitis Diagnosed?
In babies with symptoms of NEC, a diagnosis can be confirmed if an abnormal gas
pattern shows up on an X-ray. This looks like a bubbly or streaky appearance of gas
in the walls of the intestine.
In severe cases, air escapes from the intestine and shows up in the large veins
of the liver or the abdominal cavity. A doctor may insert a needle into the belly
to withdraw fluid to see whether there is a hole in the intestine.
How Is Necrotizing Enterocolitis Treated?
After diagnosis, treatment begins immediately. It includes:
- temporarily stopping all feedings
- nasogastric or orogastric drainage (inserting a tube through the nose or mouth
into the stomach to remove air and fluid from the stomach and intestine)
- IV (given into a vein) fluids for fluid replacement and nutrition
- antibiotics to treat or prevent infection
- frequent exams and abdominal X-rays
- a consultation with a pediatric surgeon to discuss surgery, if needed
- in severe cases, surgery may be needed right away
The baby's poop is watched for blood and the baby's belly size is checked regularly.
A hole in the intestine or an infection in the abdominal cavity will make the belly
swell. If a baby's belly is so swollen that it affects breathing, extra oxygen or
a breathing machine (ventilator) will help the baby breathe. Also, blood tests will
look for bacteria and check for anemia
(a decrease in red blood cells).
After responding to treatment, a baby can be back on regular feedings after a week
or two. When feedings start again, breast milk is recommended. Breast milk is beneficial
for babies with NEC because it is easily digested, supports the growth of healthy
bacteria in the intestinal tract, and boosts a baby's immunity — which is especially
important for a preterm baby with an immature immune
system.
For women who can't breastfeed or provide enough breast milk, doctors may recommend
giving the baby pasteurized human breast milk from a milk bank, which is considered
a safe alternative. Special formula may also be used.
Some babies will need surgery if their condition gets worse despite medical care.
The surgeon will look for a hole in the intestine and remove any dead or dying intestinal
tissue. In some cases after this removal, the healthy intestine can be sewn back together.
Other times, especially if the baby is very ill or a large section of the intestine
was removed, an ostomy is done. During an ostomy, surgeons bring
an area of the intestine to an opening on the abdomen (stoma) so that stool can safely
exit the body. A second surgery may be done to re-examine the intestines. If
an ostomy is made, it will be closed 6–8 weeks later, after the intestine is fully
healed and healthy again.
What Can I Expect?
Most babies who develop NEC recover fully and do not have further feeding problems.
In some cases, the intestine is scarred, narrowed, or blocked. If so, more surgery
might be needed.
Malabsorption (when the intestine can't absorb nutrients normally)
can be a lasting problem from NEC. It's more common in babies who had part of their
intestine removed. A baby with malabsorption may need nutrition delivered directly
into a vein until the intestine heals well enough to tolerate normal feeding.
If your baby has NEC, it's normal to worry. And not being able to feed your baby
can be frustrating — infants are so small, it just doesn't feel right to stop feedings
or take away that precious bonding time. But that might be the best thing for your
baby during treatment. And remember, there's a good chance that your baby will be
back on regular feedings soon.
In the meantime, ask a member of your care team what you can do to care for and
bond with your baby. There are ways you can help. Members of your care team are eager
to support parents of preemies, as well as the preemies themselves, on the path to
recovery.
Date reviewed: October 2018