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Necrotizing enterocolitis (NEC)NNecrotizing enterocolitis (NEC)Necrotizing enterocolitis (NEC)EnglishNeonatology;GastrointestinalPremature;Newborn (0-28 days);Baby (1-12 months)Stomach;Small Intestine;Large Intestine/Colon;EsophagusDigestive systemConditions and diseasesPrenatal Adult (19+) CaregiversNA2018-11-20T05:00:00Z9.7000000000000050.30000000000001333.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Necrotizing enterocolitis (NEC) is a rare but serious disease that affects the bowels of premature or newborn infants. Learn more about the symptoms, causes and treatment of the condition.</p><p>Necrotizing enterocolitis (NEC) is a condition that typically affects the <a href="/Article?contentid=1467&language=English">small or large bowels (intestines)</a> of babies who are born prematurely or at a low birth weight (<1500g). NEC can also affect full-term infants who have underlying health problems, such as heart defects or serious infections. NEC may affect only one part of the bowel or it may affect several parts. In rare cases, it can affect the entire bowel. </p><p>NEC causes inflammation and infection of the bowels. This disrupts the blood supply to the gut, making the bowels become very weak. In severe cases, the bowel becomes so weak that a hole forms (perforation). This hole allows bacteria and waste products, which are normally contained in the bowels, to leak into the abdomen and cause a dangerous infection. </p><p>NEC can be a life-threatening disease; however, most babies respond well to treatment. The bowel recovers and resumes normal function in most babies.</p> <figure class="asset-c-100"><span class="asset-image-title">Necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_V7.png" alt="Cross section of healthy small intestine compared to cross section of NEC intestine showing inflamed wall with gas bubbles" /><figcaption class="asset-image-caption">Necrotizing enterocolitis is a condition that affects the small or large intestine (bowels) of premature or low birth weight babies. A portion of the bowel can become inflamed and infected. This can cut off blood flow causing the bowel to become weak and damaged.</figcaption> </figure><h2>Key points</h2><ul><li>Necrotizing enterocolitis (NEC) is a condition that affects the small or large intestines of newborn infants. Most commonly, it affects those born prematurely or with low birth weight.</li><li>Several factors can increase a newborn’s risk of developing NEC, including: prematurity, formula feeding, difficult birth delivery, and an overgrowth of germs or bacteria in the intestines.</li><li>Symptoms of NEC include poor feeding, a swollen belly and bloody stools.</li><li>Treatment depends on the severity of the disease. NEC may be treated with antibiotics or in some cases, surgery to remove the affected bowel.</li><li>Most babies respond well to treatment and grow up without any bowel problems.</li></ul> <h2>Signs and symptoms of NEC</h2><p>NEC usually occurs three to ten days following birth. Signs and symptoms of NEC include:</p><ul><li>a red, swollen belly</li><li>problems tolerating feeds</li><li>bloody stools, including diarrhea containing blood</li><li>vomit, containing bile<br></li><li>irregular breathing</li><li>low blood pressure</li><li>a high, low or unstable temperature.</li></ul><p>Diagnosing NEC can be difficult since its symptoms, such as not tolerating feeds, vomiting, and altered bowel movements, are similar to signs of other less serious bowel conditions.</p><h2>Causes and risk factors of NEC</h2><p>While NEC can occur in any newborn baby, most cases are seen in premature babies. It is estimated that NEC affects approximately 5% of infants weighing less than 1500 grams at birth.</p><p>It is not known exactly what causes NEC, but several different factors may contribute.</p><h3>Prematurity</h3><p>Babies born <a href="/prematurebabies">prematurely</a> typically have underdeveloped immune systems and may not be able to fight infection on their own. The lower the birth weight, the more at risk a premature baby is of developing NEC.</p><h3>Formula feeding</h3><p>Babies who are given breast milk have a lower chance of developing NEC.</p><h3>Difficult delivery</h3><p>In some difficult deliveries, not enough blood, oxygen and nutrients get to the bowels. The lack of oxygenated blood to the bowels can cause damage to the intestinal wall.</p><h3>Bacteria growth</h3><p>A premature baby’s immature immune system is not able to protect the bowels from an overgrowth of bacteria and germs. This can cause swelling and infection. Taking antibiotic medication for more than ten days may also impact bacterial growth in the bowel, increasing the risk of developing NEC.</p><h2>Diagnosis of NEC</h2><p>An abdominal X-ray is used to confirm a diagnosis of NEC and to determine how severe it is. Doctors will look for swelling of the bowels, gas in the bowel walls (pneumatosis intestinalis) and free air in the belly (air outside of the bowels), which indicates that a hole has formed in the weak bowel. </p> <figure class="asset-c-100"> <span class="asset-image-title">Necrotizing enterocolitis (NEC) abdominal X-ray</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_pneumatosis_XRAY_MEDIMG_PHO_EN.png" alt="X-ray of healthy small and large intestines and x-ray of intestine affected by necrotizing enterocolitis" /> <figcaption class="asset-image-caption">In necrotizing enterocolitis, there is typically swelling of the bowels, gas in the bowel walls and free air in the abdomen (belly). This makes the baby’s belly appear swollen. </figcaption> </figure> <p>An ultrasound of the abdomen can also help confirm NEC by identifying parts of the bowel that have become thinner or if there is a change in blood flow to certain parts of the bowel.</p><p>NEC can significantly affect the absorption of nutrients into the body and the removal of waste products. In addition to imaging scans, a baby with suspected NEC will have blood tests to check for:</p><ul><li>evidence of infection (white blood cell count, blood culture, c-reactive protein)</li><li>the balance of nutrients and chemicals in their blood.</li></ul><h2>Treatment of NEC</h2><p>When there is a concern that a baby may have NEC or when the diagnosis has been confirmed, the baby is not given any food into their stomach. Liquids and nutrients (fat, sugar and salt) are given intravenously. A tube is placed into the stomach, either through the nose — <a href="/Article?contentid=984&language=English">nasogastric (NG)</a> — or the mouth — orogastric (OG) — to remove any extra liquids or air. Babies may be given IV (intravenous) antibiotics to treat the infection. The baby will be on antibiotics for seven to 14 days. In most cases, this treatment is effective and surgery will not be required. </p><p>About one third of babies may need surgery to remove the diseased bowel. In most surgical cases, the diseased bowel is removed and the healthy pieces are joined back together. </p><p>However, if there is disease in several areas of the bowel the surgeon may pull the end of the healthy section through the abdomen, creating an opening in the skin called an ostomy. Stool or poop will pass through the ostomy into a bag. This allows the affected areas of the bowel to heal. </p> <figure class="asset-c-100"> <span class="asset-image-title">Surgery as treatment for necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_surgeryv2.png" alt="Removing diseased part of bowel and creating ostomy in first surgery and joining cut ends of bowel in second surgery" /><figcaption class="asset-image-caption">One third of babies with NEC may require surgery for treatment. Two separate surgeries will be performed. The first surgery is to remove the diseased part of the bowel (1a). A healthy end of the bowel will then be attached to the abdomen, creating an opening in the skin called an ostomy (1b). After several weeks a second surgery will attach the end of the bowel used for the ostomy to another healthy end of the bowel.</figcaption> </figure> <p>Once the bowel has healed, the baby will need a second surgery to close the stoma and reconnect the healthy section to the healed part of the bowel. Your child will no longer have an ostomy and will be able to pass stool normally through the anus.<br></p><p>While your baby’s bowel heals, fluids and nutrients will be given by IV into their bloodstream. Once the bowel becomes healthy enough, approximately one to two weeks after treatment, your baby may be fed milk through an NG tube into their stomach. </p><p>If possible, it is best to feed your baby breast milk once they can receive feedings again.</p><p>SickKids Neonatology Clinic: <a href="http://www.sickkids.ca/Neonatology/">http://www.sickkids.ca/Neonatology/</a></p><p>American Pediatric Surgical Association: <a href="https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-%28nec%29/">https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-(nec)/</a> </p><p>Children’s Hospital Los Angeles: <a href="https://www.chla.org/necrotizing-enterocolitis">https://www.chla.org/necrotizing-enterocolitis</a></p><p>The Children’s Hospital of Philadelphia: <a href="https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis">https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis</a><br></p><p>Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing Enterocolitis Risk: State of the Science. Adv Neonatal Care 2012; 77–89.</p><p>Neu J. Neonatal Necrotizing Enterocolitis. Karger Publishers, 2013: 122–7.</p><p>Alexander V, Northrup V, Bizzarro M. Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis. The Journal of Pediatrics 2011; 392-397.</p><p>Necrotizing Enterocolitis. Child. Hosp. Los Angeles. 2016. <a href="https://www.chla.org/necrotizing-enterocolitis">http://www.chla.org/necrotizing-enterocolitis</a> (accessed June 22, 2018).</p><p>Necrotizing Enterocolitis (NEC). Am. Pediatr. Surg. Assoc. http://www.pediatricsurgerymd.org (accessed June 22, 2018).</p>
Entérocolite nécrosante néonatale (ECN)EEntérocolite nécrosante néonatale (ECN)Necrotizing enterocolitis (NEC)FrenchNeonatology;GastrointestinalPremature;Newborn (0-28 days);Baby (1-12 months)Stomach;Small Intestine;Large Intestine/Colon;EsophagusDigestive systemConditions and diseasesPrenatal Adult (19+)NA2018-11-20T05:00:00Z9.8000000000000054.9000000000000420.000000000000Health (A-Z) - ConditionsHealth A-Z<p>L’entérocolite nécrosante néonatale (ECN) est une maladie rare mais grave qui affecte les intestins des bébés prématurés ou des nouveau-nés. Apprenez-en davantage sur les symptômes, les causes et le traitement de cette maladie.</p><p>L’entérocolite nécrosante néonatale (ECN) est une maladie qui affecte généralement le <a href="/Article?contentid=1467&language=French">gros intestin ou l’intestin grêle</a> des bébés nés prématurément ou qui ont un faible poids à la naissance (moins de 1,5 kg). L’ECN peut également toucher les nourrissons à terme qui ont des problèmes de santé sous-jacents tels que des malformations cardiaques ou des infections graves. Elle peut affecter une partie seulement ou plusieurs parties de l’intestin. Dans de rares cas, elle peut s’étendre à l’intestin tout entier.</p><p>L’ECN provoque une inflammation et une infection de l’intestin qui perturbe l’irrigation sanguine intestinale, ce qui rend les intestins très faibles. Dans les cas graves, l’intestin devient tellement faible qu’une ouverture s’y crée (perforation). Cette ouverture laisse les bactéries et les déchets qui sont normalement contenus dans les intestins s’infiltrer dans l’abdomen et causer une infection dangereuse.</p><p>L’ECN peut mettre la vie des bébés en danger, mais la plupart d’entre eux réagissent bien au traitement. L’intestin se rétablit et reprend son fonctionnement normal.</p> <figure class="asset-c-100"> <span class="asset-image-title">Entérocolite nécrosante néonatale (ECN)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_V7.png" alt="Cross section of healthy small intestine compared to cross section of NEC intestine showing inflamed wall with gas bubbles" /> <figcaption class="asset-image-caption">L’entérocolite nécrosante néonatale est une maladie qui affecte le gros intestin ou l’intestin grêle des bébés prématurés ou qui ont un faible poids à la naissance. Une partie de l’intestin peut s’enflammer et s’infecter, ce qui provoque une diminution de la circulation sanguine qui, à son tour, affaiblit et endommage l’intestin.</figcaption> </figure> <h2>À retenir </h2><ul><li>L’entérocolite nécrosante néonatale (ECN) est une maladie qui affecte le gros intestin ou l’intestin grêle du nouveau-né. Le plus souvent, elle touche les enfants nés prématurément ou qui ont un faible poids à la naissance.</li><li>Plusieurs facteurs peuvent augmenter le risque qu’un nouveau-né développe une ECN, notamment la prématurité, l’alimentation artificielle, un accouchement difficile et la prolifération de microbes ou de bactéries dans l’intestin.</li> <li>Les symptômes de l’ECN comprennent une mauvaise alimentation, un ventre gonflé et des selles sanguinolentes.</li><li>Le traitement de l’ECN dépend de sa gravité. Elle peut être traitée à l’aide d’antibiotiques ou, dans certains cas, de l’ablation de la région de l’intestin atteinte.</li><li>La plupart des bébés réagissent bien au traitement et grandissent sans problèmes intestinaux. </li></ul><h2>Symptômes de l’ECN</h2><p>L’ECN survient habituellement de trois à dix jours après la naissance. Les symptômes de cette maladie sont les suivants :</p><ul><li>un ventre rouge et gonflé;</li><li>des difficultés à tolérer l’allaitement;</li><li>des selles sanguinolentes, y compris une diarrhée sanglante;</li><li>des vomissements contenant de la bile;</li><li>une respiration irrégulière;</li><li>une tension artérielle basse;</li><li>une température élevée, basse ou instable.</li></ul><p>Il est assez difficile de diagnostiquer l’ECN, car ses symptômes, comme l’intolérance à l’allaitement, les vomissements et la modification des selles, sont semblables à ceux d’autres troubles intestinaux moins graves.</p><h2>Causes et facteurs de risque de l’ECN</h2><p>Bien que l’ECN puisse survenir chez n’importe quel nouveau-né, la plupart des cas sont observés chez les bébés prématurés. On estime qu’elle touche environ 5 % des nourrissons pesant moins de 1,5 kg à la naissance.</p><p>On en connaît mal les causes exactes, mais plusieurs facteurs différents peuvent y contribuer.</p><h3>Prématurité</h3><p>Le système immunitaire des bébés nés prématurément est généralement sous-développé, donc peu apte à combattre l’infection. Plus le poids à la naissance est faible, plus le risque qu’un bébé prématuré développe une ECN est élevé.</p><h3>Allaitement artificiel</h3><p>Les bébés nourris au sein ont moins de chances de développer une ECN.</p><h3>Accouchement difficile</h3><p>Lors de certains accouchements difficiles, trop peu de sang, d’oxygène et de nutriments se rendent aux intestins. Un manque de sang oxygéné dans les intestins peut endommager la paroi intestinale.</p><h3>Croissance de bactéries</h3><p>Le système immunitaire immature d’un bébé prématuré n’est pas en mesure de protéger adéquatement les intestins contre une prolifération de bactéries et de microbes. De l’enflure et de l’infection peuvent s’ensuivre. La prise d’antibiotiques pendant plus de dix jours peut également influer sur la croissance bactérienne dans l’intestin, augmentant le risque de développer une ECN.</p><h2>Diagnostic de l’ECN</h2><p>Une radiographie abdominale permettra de confirmer un diagnostic d’ECN et d’en déterminer la gravité. Les médecins rechercheront la présence d’un gonflement des intestins, de gaz dans les parois intestinales (pneumatose intestinale) et d’air dans l’abdomen (à l’extérieur des intestins), ce qui indique qu’une ouverture s’est formée dans l’intestin faible.</p> <figure class="asset-c-100"> <span class="asset-image-title">Radiographie abdominale d’une entérocolite nécrosante néonatale (ECN)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_pneumatosis_XRAY_MEDIMG_PHO_EN.png" alt="X-ray of healthy small and large intestines and x-ray of intestine affected by necrotizing enterocolitis" /> <figcaption class="asset-image-caption">L’entérocolite nécrosante néonatale entraîne généralement un gonflement des intestins, des gaz dans les parois intestinales et de l’air dans l’abdomen, ce qui donne l’impression que le ventre du bébé est gonflé. </figcaption> </figure> <p>Une échographie de l’abdomen pourra également faciliter le diagnostic d’une ECN en révélant les parties de l’intestin qui se sont amincies ou une diminution du flux sanguin vers certaines régions de l’intestin.</p><p>L’ECN peut compromettre de manière importante l’absorption des nutriments et l’élimination des déchets. En plus des imageries, le bébé chez qui l’on soupçonne la présence d’ECN devra subir des analyses de sang dans les buts suivants :</p><ul><li>déceler des signes d’infection (dénombrement des globules blancs, hémoculture, protéine C-réactive);</li><li>déterminer l’équilibre des éléments nutritifs et chimiques dans son sang.</li></ul><h2>Traitement de l’ECN</h2><p>Lorsqu’on craint qu’un bébé ne soit atteint d’une ECN ou lorsque le diagnostic a été confirmé, aucun solide ne lui est donné. On lui administre plutôt des liquides et des nutriments (matières grasses, sucre et sel) par voie intraveineuse. On place un tube dans l’estomac, soit par le nez (<a href="/Article?contentid=984&language=French">sonde nasogastrique</a>) ou par la bouche (sonde orogastrique), pour éliminer tout liquide ou air excédentaire. On administrera normalement au bébé des antibiotiques intraveineux de 7 à 14 jours pour traiter l’infection. Dans la plupart des cas, ce traitement est efficace et aucune opération ne sera nécessaire.</p><p>Environ un tiers des bébés peuvent avoir besoin d’une l’ablation d’une région de l’intestin malade. Dans la plupart des cas, elle est retirée et les parties saines de l’intestin sont rattachées.</p><p>Toutefois, si plusieurs régions de l’intestin sont malades, le chirurgien pourra étirer l’extrémité de la section saine jusqu’à la peau afin d’y créer une ouverture appelée stomie. Les selles passeront par la stomie pour se jeter dans un sac, ce qui permettra aux régions affectées de l’intestin de guérir.</p> <figure class="asset-c-100"> <span class="asset-image-title">Opération de l’ECN</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_surgeryv2.png" alt="Removing diseased part of bowel and creating ostomy in first surgery and joining cut ends of bowel in second surgery" /> <figcaption class="asset-image-caption">Un tiers des bébés atteints d’ECN auront probablement besoin d’une intervention chirurgicale pour la traiter. Deux opérations distinctes seront alors pratiquées. La première consistera à enlever la région malade de l’intestin (1a). L’extrémité saine de l’intestin sera alors attachée à l’abdomen, ce qui formera une ouverture dans la peau appelée stomie (1b). Après plusieurs semaines, une deuxième opération réunira l’extrémité de l’intestin utilisée pour la stomie à l’extrémité saine de l’intestin.</figcaption> </figure> <p>Une fois l’intestin guéri, le bébé aura besoin d’une deuxième intervention chirurgicale pour fermer la stomie et pour reconnecter la partie saine à la partie guérie de l’intestin. Votre enfant n’ayant plus de stomie, il pourra évacuer ses selles normalement par l’anus.</p><p>Pendant la cicatrisation intestinale de votre bébé, des liquides et des nutriments lui seront injectés par voie intraveineuse. Une fois que l’intestin se sera suffisamment assaini, soit environ une à deux semaines après le traitement, votre bébé pourra être nourri au lait par sonde nasogastrique dans l’estomac.</p><p>Si possible, il sera préférable d’allaiter votre bébé dès qu’il aura recommencé à téter.</p><p>SickKids Neonatology Clinic: <a href="http://www.sickkids.ca/Neonatology/">http://www.sickkids.ca/Neonatology/</a></p><p>American Pediatric Surgical Association: <a href="https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-%28nec%29/">https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-(nec)/</a> </p><p>Children’s Hospital Los Angeles: <a href="https://www.chla.org/necrotizing-enterocolitis">https://www.chla.org/necrotizing-enterocolitis</a></p><p>The Children’s Hospital of Philadelphia: <a href="https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis">https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis</a><br></p><p>Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing Enterocolitis Risk: State of the Science. Adv Neonatal Care 2012; 77–89.</p><p>Neu J. Neonatal Necrotizing Enterocolitis. Karger Publishers, 2013: 122–7.</p><p>Alexander V, Northrup V, Bizzarro M. Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis. The Journal of Pediatrics 2011; 392-397.</p><p>Necrotizing Enterocolitis. Child. Hosp. Los Angeles. 2016. <a href="http://www.chla.org/necrotizingenterocolitis">http://www.chla.org/necrotizingenterocolitis</a> (accessed June 22, 2018).</p><p>Necrotizing Enterocolitis (NEC). Am. Pediatr. Surg. Assoc. http://www.pediatricsurgerymd.org (accessed June 22, 2018).</p>

 

 

 

 

Necrotizing enterocolitis (NEC)1769.00000000000Necrotizing enterocolitis (NEC)Necrotizing enterocolitis (NEC)NEnglishNeonatology;GastrointestinalPremature;Newborn (0-28 days);Baby (1-12 months)Stomach;Small Intestine;Large Intestine/Colon;EsophagusDigestive systemConditions and diseasesPrenatal Adult (19+) CaregiversNA2018-11-20T05:00:00Z9.7000000000000050.30000000000001333.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Necrotizing enterocolitis (NEC) is a rare but serious disease that affects the bowels of premature or newborn infants. Learn more about the symptoms, causes and treatment of the condition.</p><p>Necrotizing enterocolitis (NEC) is a condition that typically affects the <a href="/Article?contentid=1467&language=English">small or large bowels (intestines)</a> of babies who are born prematurely or at a low birth weight (<1500g). NEC can also affect full-term infants who have underlying health problems, such as heart defects or serious infections. NEC may affect only one part of the bowel or it may affect several parts. In rare cases, it can affect the entire bowel. </p><p>NEC causes inflammation and infection of the bowels. This disrupts the blood supply to the gut, making the bowels become very weak. In severe cases, the bowel becomes so weak that a hole forms (perforation). This hole allows bacteria and waste products, which are normally contained in the bowels, to leak into the abdomen and cause a dangerous infection. </p><p>NEC can be a life-threatening disease; however, most babies respond well to treatment. The bowel recovers and resumes normal function in most babies.</p> <figure class="asset-c-100"><span class="asset-image-title">Necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_V7.png" alt="Cross section of healthy small intestine compared to cross section of NEC intestine showing inflamed wall with gas bubbles" /><figcaption class="asset-image-caption">Necrotizing enterocolitis is a condition that affects the small or large intestine (bowels) of premature or low birth weight babies. A portion of the bowel can become inflamed and infected. This can cut off blood flow causing the bowel to become weak and damaged.</figcaption> </figure><h2>Key points</h2><ul><li>Necrotizing enterocolitis (NEC) is a condition that affects the small or large intestines of newborn infants. Most commonly, it affects those born prematurely or with low birth weight.</li><li>Several factors can increase a newborn’s risk of developing NEC, including: prematurity, formula feeding, difficult birth delivery, and an overgrowth of germs or bacteria in the intestines.</li><li>Symptoms of NEC include poor feeding, a swollen belly and bloody stools.</li><li>Treatment depends on the severity of the disease. NEC may be treated with antibiotics or in some cases, surgery to remove the affected bowel.</li><li>Most babies respond well to treatment and grow up without any bowel problems.</li></ul> <h2>Signs and symptoms of NEC</h2><p>NEC usually occurs three to ten days following birth. Signs and symptoms of NEC include:</p><ul><li>a red, swollen belly</li><li>problems tolerating feeds</li><li>bloody stools, including diarrhea containing blood</li><li>vomit, containing bile<br></li><li>irregular breathing</li><li>low blood pressure</li><li>a high, low or unstable temperature.</li></ul><p>Diagnosing NEC can be difficult since its symptoms, such as not tolerating feeds, vomiting, and altered bowel movements, are similar to signs of other less serious bowel conditions.</p><h2>Causes and risk factors of NEC</h2><p>While NEC can occur in any newborn baby, most cases are seen in premature babies. It is estimated that NEC affects approximately 5% of infants weighing less than 1500 grams at birth.</p><p>It is not known exactly what causes NEC, but several different factors may contribute.</p><h3>Prematurity</h3><p>Babies born <a href="/prematurebabies">prematurely</a> typically have underdeveloped immune systems and may not be able to fight infection on their own. The lower the birth weight, the more at risk a premature baby is of developing NEC.</p><h3>Formula feeding</h3><p>Babies who are given breast milk have a lower chance of developing NEC.</p><h3>Difficult delivery</h3><p>In some difficult deliveries, not enough blood, oxygen and nutrients get to the bowels. The lack of oxygenated blood to the bowels can cause damage to the intestinal wall.</p><h3>Bacteria growth</h3><p>A premature baby’s immature immune system is not able to protect the bowels from an overgrowth of bacteria and germs. This can cause swelling and infection. Taking antibiotic medication for more than ten days may also impact bacterial growth in the bowel, increasing the risk of developing NEC.</p><h2>Diagnosis of NEC</h2><p>An abdominal X-ray is used to confirm a diagnosis of NEC and to determine how severe it is. Doctors will look for swelling of the bowels, gas in the bowel walls (pneumatosis intestinalis) and free air in the belly (air outside of the bowels), which indicates that a hole has formed in the weak bowel. </p> <figure class="asset-c-100"> <span class="asset-image-title">Necrotizing enterocolitis (NEC) abdominal X-ray</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_pneumatosis_XRAY_MEDIMG_PHO_EN.png" alt="X-ray of healthy small and large intestines and x-ray of intestine affected by necrotizing enterocolitis" /> <figcaption class="asset-image-caption">In necrotizing enterocolitis, there is typically swelling of the bowels, gas in the bowel walls and free air in the abdomen (belly). This makes the baby’s belly appear swollen. </figcaption> </figure> <p>An ultrasound of the abdomen can also help confirm NEC by identifying parts of the bowel that have become thinner or if there is a change in blood flow to certain parts of the bowel.</p><p>NEC can significantly affect the absorption of nutrients into the body and the removal of waste products. In addition to imaging scans, a baby with suspected NEC will have blood tests to check for:</p><ul><li>evidence of infection (white blood cell count, blood culture, c-reactive protein)</li><li>the balance of nutrients and chemicals in their blood.</li></ul><h2>Treatment of NEC</h2><p>When there is a concern that a baby may have NEC or when the diagnosis has been confirmed, the baby is not given any food into their stomach. Liquids and nutrients (fat, sugar and salt) are given intravenously. A tube is placed into the stomach, either through the nose — <a href="/Article?contentid=984&language=English">nasogastric (NG)</a> — or the mouth — orogastric (OG) — to remove any extra liquids or air. Babies may be given IV (intravenous) antibiotics to treat the infection. The baby will be on antibiotics for seven to 14 days. In most cases, this treatment is effective and surgery will not be required. </p><p>About one third of babies may need surgery to remove the diseased bowel. In most surgical cases, the diseased bowel is removed and the healthy pieces are joined back together. </p><p>However, if there is disease in several areas of the bowel the surgeon may pull the end of the healthy section through the abdomen, creating an opening in the skin called an ostomy. Stool or poop will pass through the ostomy into a bag. This allows the affected areas of the bowel to heal. </p> <figure class="asset-c-100"> <span class="asset-image-title">Surgery as treatment for necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_surgeryv2.png" alt="Removing diseased part of bowel and creating ostomy in first surgery and joining cut ends of bowel in second surgery" /><figcaption class="asset-image-caption">One third of babies with NEC may require surgery for treatment. Two separate surgeries will be performed. The first surgery is to remove the diseased part of the bowel (1a). A healthy end of the bowel will then be attached to the abdomen, creating an opening in the skin called an ostomy (1b). After several weeks a second surgery will attach the end of the bowel used for the ostomy to another healthy end of the bowel.</figcaption> </figure> <p>Once the bowel has healed, the baby will need a second surgery to close the stoma and reconnect the healthy section to the healed part of the bowel. Your child will no longer have an ostomy and will be able to pass stool normally through the anus.<br></p><p>While your baby’s bowel heals, fluids and nutrients will be given by IV into their bloodstream. Once the bowel becomes healthy enough, approximately one to two weeks after treatment, your baby may be fed milk through an NG tube into their stomach. </p><p>If possible, it is best to feed your baby breast milk once they can receive feedings again.</p><h2>Outlook for babies with NEC</h2><p>Most babies respond well to treatment and grow up without any intestinal or feeding problems. In rare cases, NEC may occur again.</p><p>Although rare, it is also possible that the development of scar tissue will cause the bowel to become narrow when it heals. This may block poop and gas from coming out and may require surgery to correct it. This narrowing is more common in babies who have had surgery to remove large sections of their bowel.</p><p>SickKids Neonatology Clinic: <a href="http://www.sickkids.ca/Neonatology/">http://www.sickkids.ca/Neonatology/</a></p><p>American Pediatric Surgical Association: <a href="https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-%28nec%29/">https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-(nec)/</a> </p><p>Children’s Hospital Los Angeles: <a href="https://www.chla.org/necrotizing-enterocolitis">https://www.chla.org/necrotizing-enterocolitis</a></p><p>The Children’s Hospital of Philadelphia: <a href="https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis">https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis</a><br></p><p>Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing Enterocolitis Risk: State of the Science. Adv Neonatal Care 2012; 77–89.</p><p>Neu J. Neonatal Necrotizing Enterocolitis. Karger Publishers, 2013: 122–7.</p><p>Alexander V, Northrup V, Bizzarro M. Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis. The Journal of Pediatrics 2011; 392-397.</p><p>Necrotizing Enterocolitis. Child. Hosp. Los Angeles. 2016. <a href="https://www.chla.org/necrotizing-enterocolitis">http://www.chla.org/necrotizing-enterocolitis</a> (accessed June 22, 2018).</p><p>Necrotizing Enterocolitis (NEC). Am. Pediatr. Surg. Assoc. http://www.pediatricsurgerymd.org (accessed June 22, 2018).</p>https://assets.aboutkidshealth.ca/akhassets/NEC_V7.pngNecrotizing enterocolitis (NEC)False

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