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Necrotizing Enterocolitis

  • Necrotizing enterocolitis is (NEC) is a serious intestinal illness in babies that results in the death of intestinal tissues.

    Premature babies or sick newborns are at the greatest risk for necrotizing enterocolitis.

    • 60 to 80 percent of cases occurs in premature babies.
    • NEC occurs in about 10 percent of babies weighing less than 3 pounds, 5 ounces.

    How Boston Children's Hospital approaches necrotizing enterocolitis

    Children's Center for Advanced Intestinal Rehabilitation team actively participates in research focused on the treatment and understanding of gastrointestinal disorders. Children's doctors developed the serial transverse enteroplasty (STEP) procedure, a surgical technique developed for use in treating gastrointestinal disorders.

    Boston Children's Hospital
    333 Longwood Avenue,
    Fegan 3
    Boston MA 02115

     617-355-5275
  • Your doctor will examine your baby for the following symptoms:

    • abdominal distention (bloating or swelling)
    • feedings stay in stomach
    • bile-colored (green) fluid in stomach
    • bloody bowel movements
    • signs of infection such as apnea (stopping breathing), low heart rate, lethargy (sluggishness)

    We may then suggest an x-ray to look for air in the intestines or the large veins of the liver.

    In some cases, your doctor may insert a needle into your baby's abdominal cavity. Withdrawing intestinal fluid from the abdomen is often a sign of necrotizing enterocolitis.

  • Treatment for necrotizing enterocolitis may include the following:

    • stopping feedings
    • inserting a nasogastric (NG) tube (nose into stomach) to keep stomach empty
    • intravenous fluids (IV) for nutrition and fluid replacement
    • antibiotics for infection
    • frequent x-rays to monitor the progress of the disease
    • extra oxygen or mechanically assisted breathing
    • isolation procedures (such as protective gowns and gloves) to keep any infection from spreading

    In more severe cases, babies with NEC may require:

    • surgery to remove diseased intestine or bowel
    • connecting part of the intestine or bowel to an ostomy (opening on the abdomen)
  • Austin's story

    Austin Day 1It was 3:08 a.m. on March 3, 2005, when the most beautiful miracle came into this world. Austin Thomas weighed 1 lb., 14 oz. and was 13 inches long. He made his debut 15 weeks earlier than his June 14 due date had predicted. Although he was tiny and had a lot of developing to do, he was absolutely perfect. It was amazing that a person so small could have such perfect fingers and perfect toes and be so beautiful. In those first few hours it would be hard to comprehend the torturous road this precious baby would have to travel and the battles he would have to fight to stay here with us.

    Less than 24 hours after his birth, Austin was transported to Children’s Hospital Boston where he would live for the next seven months and for what would be the first of seven surgeries he would have to undergo in the next five months. Austin had two heart surgeries; one to fix a puncture made around the lining of his heart during the insertion of one of his many tubes; the second to close his patent ductus arteriosus (PDA) — an opening between the aorta and the pulmonary artery which usually closes on its own after birth.)

    Austin Day 3Before his PDA surgery, doctors tried to medically close the opening, which caused a “blowout” (a hole) in his bowels, so that had to be surgically repaired as well.

    Austinalso had another surgery — leaving a large scar across his back — to remove fluid that had been building up in his lungs. I always marveled at how much strength this tiny baby had to have to make it through all these surgeries, and I thanked God every day for the skill of the surgeons who could do these surgeries and save these babies.

    As bad as things seemed, my world came crashing down when I received a call from the nurse letting me know Austin was bleeding rectally and they did not yet know the cause. Although I spent every day and night with Austin, I was advised to go home to sleep, to try to keep up my strength. It was moments like this when I would regret the decision to leave. I spent the day with him and was shocked to see how badly he was bleeding, but was still hoping it was something that would pass — a side effect of being a preemie possibly.

    On April 20, 2005, Austin underwent his scariest surgery yet.  I knew something was wrong when the surgeon came out to talk to us only 20 minutes after beginning surgery. Austin had a condition called necrotizing enterocolitis (NEC). As it was explained to us, it appeared as if cement was poured into Austin’s belly. All of his intestines had fused together in one lump. Trying to separate the bowels at this stage would only cause severe damage and tear the bowels apart. The surgeon said it was the worst case she had ever seen. As a mom I hoped that just meant she hadn’t seen many. Then the words a mother never wants to hear: I was informed we would have to wait for 48 hours before even discussing options, because the surgeon did not see much reason for this discussion. After all Austin had been through I was going to lose my baby.

    I prayed through the night, but not the prayers you would think. I prayed that if he was not going to make it through this, or anything else that was yet to come, that I wanted God to take him now. It was selfish of me to keep this baby fighting so hard for me. If the end results were not going to be good, I did not want him to suffer any longer.      

    Dr. Puder and AustinI’m glad he didn’t listen, because the next day I met the man who I consider to be my own special angel. Dr. Mark Puder approached me while I was standing next to Austin’s bed and asked to speak to me. A few of the nurses that watched Austin (and did it amazingly, too) had approached him asking if there was anything he could do to help us. The truth was, even if Austin survived NEC, he was facing a scary future. Because NEC is a bowel disease, Austin was not allowed, nor could he, take food by mouth. He would be fed through an IV. This type of feeding is called total parenteral nutrition (TPN). Although these feedings keep babies alive and provide the nutrients they need, they also cause some severe side effects. The most disturbing was the likelihood of Austin needing a liver transplant due to the damage TPN causes to the liver. So basically the liquid they were giving him to keep him alive could also kill him.

    I knew all of this when I sat down with Dr. Puder. He started off by saying, “I hope you say no.” He explained to me that TPN is made up of two parts. One part that was loaded with the vitamins that Austin needed and another part were essential fats (lipids). These lipids were made from plants. Dr. Puder explained that based on some research he had done, he believed that these fats are what do the actual damage to the liver. Dr. Puder had a replacement to offer me. This replacement was not approved by the FDA yet and would take some special permission to administer to my baby.

    The other thing I needed to think about was that there was only one other child receiving this product. This child was getting better. His liver function had improved, but he was also allowed to have some food by mouth, which is a natural way to heal the liver. So Austin would be the first baby receiving no other form of nutrition. Because he had little in the way of “proof” to show me, Dr. Puder had hoped I would say “no.” No good doctor wants to give a desperate mother hope and not deliver. I could tell by the way he spoke, that his hesitations were for me, but that he truly believed in what he was doing. He wanted to give me time to think it over, but I said “I don’t need any time. Tell me where to sign.” I was told my baby might not make it 48 hours, so I would have done anything to give him a chance to survive.

    This miracle is called Omegaven. Austin would be given it intravenously once a day and it would replace the lipid portion of the TPN. Unlike the lipids, Omegaven was made with fish fats rather than plant fats. Dr. Puder said it would take two weeks to start to show any results and they would test his liver functions daily to check. At the beginning of treatment, Austin looked like any other preemie going through all he was going through. The whites of his eyes were grey, his skin was yellow, and he was so thin you could make out all the ribs in his back. Dr. Puder visited every day and would let me know what the tests were showing.

    Austin day 2As if it were the magic number, two weeks almost to the day after Austin received the first dose of Omegaven, his bilirubin levels began to drop. These levels are associated with liver function and the higher they go the worse for your baby. It’s what makes them look yellow and their eyes grey. From that day forward, it was almost a daily occurrence. His once off-the-chart-levels were slowly decreasing, which is just the opposite of what usually happens to anyone who cannot eat and is only being fed by TPN.

    Austin’s skin started to turn pink, his beautiful blue eyes were bright and he was gaining weight! All of these alone were reason to celebrate. NEC causes some irreversible damage and there is always a reconstructive surgery planned to remove the damaged part of the bowel. In most cases surgeons wait at least three months to give the bowels enough time to heal, but they can perform these reconstructions as soon as six weeks if the health of babies is failing. Because there is less healing time, there’s more risk of the bowels still being stuck together in too many spots and causing further damage.

    As much I would have liked it all be over with, I am happy to announce that Austin was able to have a full three-month recovery time due to his improving, not failing, health. Because he had the time to heal, Austin only lost 12.6 inches of his 26.7-inch bowels. His reconstructive surgery was done by Dr. Tom Jaksic, an amazing surgeon. He informed me that the part of his bowels that Austin lost should not inhibit him at all and he will adapt to the smaller bowel and live a normal life filled with McDonald’s and junk food. Not only had Austin survived the “worst” case of NEC one surgeon had ever seen, but he was a chubby faced, pink-cheeked baby who had defied all odds.

    Austinhad one small setback after his surgery and we had to delay the start of mouth feeding. But he finally came home on October 7, 2005, (7 months and 4 days old). We still attend the small bowel clinic with Dr. Jaksic and his team of incredible doctors. We often stop and visit some of his old nurses who always let me know that they had feared I would one day leave that hospital, but would not be taking a baby home with me.

    Austinis just about to celebrate his fifth birthday. He has none of the telltale signs of being a preemie (sunken cheeks, long face, smaller size). He is one of the tallest kids in his class, has the round face of a five-year-old and people are amazed to hear he could have been so small. Besides the many scars that adorn Austin’s belly and back, there is no way of knowing what this child has gone through. He has no delays in school, makes friends easily and has a memory that anyone would be jealous of.

    I spent seven months — day and night — at Children’s, and I am humbled by what I have seen. Even with all that I went through to bring my baby home, I know I am one of the lucky ones. I am thankful for all of Austin’s great nurses, for all the many doctors who gave him care, and for Dr. Jaksic who handled such a delicate surgery and “fixed” my baby’s belly.

    Austin ChristmasI do, however, hold a special place in my heart for one doctor. Dr. Mark Puder will forever be an angel sent to us. I know in my heart, no matter what else had happened, the reason Austin is here today is because of him. The reason Austin is a healthy boy about to attend kindergarten and thriving in everything he does is because Dr. Puder saw a sad and desperate mother who would not give up on her son, and took a chance with a product he believed in and that saved my baby’s life.

    So to Dr. Puder, Dr. Jaksic and every other person at Children’s Hospital Boston who made it possible for me to be a mother, as I had always dreamed to be, I thank you from the bottom of my heart. You will never fully understand the magnitude of what you do each day and the dreams you help come true.

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