Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a serious intestinal illness in babies that results in the death of intestinal tissues. NEC can lead to holes or areas of narrowing (strictures) in the intestines and is a cause of short bowel syndrome (SBS). In SBS, a child lacks enough small intestine to absorb all the nutrition their growing body needs.

What causes necrotizing enterocolitis?

The cause of necrotizing enterocolitis (NEC) is unknown. Premature babies or sick newborns are at the greatest risk for NEC, which occurs in about 10 percent of babies weighing less than 3 pounds, 5 ounces.

How is necrotizing enterocolitis diagnosed?

Your doctor will examine your baby for the following symptoms:

  • abdominal distention (bloating or swelling)
  • feedings that stay in the stomach
  • bile-colored (green) fluid in stomach
  • bloody bowel movements
  • signs of infection such as apnea (stopping breathing), low heart rate, and 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 to look for intestinal fluid, which is often a sign of NEC.

How is necrotizing enterocolitis treated?

Treatment for NEC may include the following:

  • stopping feedings
  • inserting a nasogastric (NG) tube (nose into stomach) to keep the 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)  

How we care for necrotizing enterocolitis

At Boston Children's Hospital, we treat children with NEC in our Center for Advanced Intestinal Rehabilitation (CAIR), which includes a team of experts with decades of experience in caring for children with intestinal problems and their families. Our specialists include:

  • physicians trained in surgery, gastroenterology, and nutrition
  • registered dieticians
  • nurse practitioners
  • nurses
  • pharmacist
  • social worker