Necrotizing enterocolitis (NEC) is a condition where the intestines become infected and can begin to die. The disease usually affects premature babies, although term babies may also get NEC. Necrotizing enterocolitis is a serious condition that may require surgery and has a high morbidity and mortality rate.

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Father touching head of a premature baby in a incubator at the Neonatal Intensive Care

Overview

The inner lining of the intestines contains millions of bacteria. Usually, these bacteria (called the normal flora) are harmless and are part of the digestive process.

In NEC, though, the bacteria begin to attack the intestinal wall. If the disease is not treated promptly, the intestinal wall will weaken and may die.

Eventually, a hole can form through the bowel wall (a perforation), spilling its contents into the abdominal cavity. Bowel perforation is a medical emergency that requires immediate surgery and has a high mortality rate.

Necrotizing Enterocolitis Overview

Causes

Prematurity is the biggest risk factor for the development of NEC because preemies are born with immature intestines. Beyond that, physicians aren’t exactly sure what causes NEC.They know that the vast majority of infants who get NEC have begun milk feedings, but they also know that delaying feedings does not reduce the frequency of the disorder.

Reduced blood flow to the intestines may also play a factor in the development of necrotizing enterocolitis, and babies who have heart conditions such as a patent ductus arteriosis (PDA) are at higher risk for developing NEC.

Symptoms

Eventually, the bowel will rupture, causing widespread infection and respiratory distress.

Treatment

If medical treatment is not working or if the bowel perforates, surgery is required. A surgeon will remove any dead sections of bowel and other infected material. The bowel will either be reattached or will be diverted to the abdomen through a stoma. Medical treatments will continue until the disease is resolved.

Prognosis

NEC is a serious disease, and infants who recover from NEC are at a greater risk of developing long-term problems. Infants who are medically treated for NEC may have growth delays, trouble absorbing nutrients, and trouble with their livers and gall bladders. NEC also increases the risk of developmental delays.

Infants who have had surgery for NEC also show long-term effects from the disease. In addition to the effects of medical NEC, surgical patients may have severe absorption problems such asshort bowel syndromeand have an increased risk ofcerebral palsyand brain and eye problems.

Prevention

Preventing premature birth is the best way to prevent necrotizing enterocolitis. If you are at risk for preterm birth, talk with your physician about what you can do to lower your risk.

If preterm birth does occur, then feeding only breast milk can significantly lower the risk of NEC. Breast milk contains protective factors that encourage good intestinal development and can reduce the amount of harmful bacteria in the intestines. In one study, infants whose feedings contained at least 50% breast milk had a six-fold decrease in the incidence of NEC.

In addition to preventing preterm birth and feeding breast milk, giving steroids to the mother when premature birth is expected may reduce the risk of NEC. Also, supplementing breast milk and formula with different substances such as probiotics or immunoglobulins may help, although more research is needed.

12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alganabi M, Lee C, Bindi E, Li B, Pierro A.Recent advances in understanding necrotizing enterocolitis.F1000Res. 2019 Jan;8(1):1-8. doi:10.12688/f1000research.17228.1Yu L, Tian J, Zhao X, et al.Bowel perforation in premature infants with necrotizing enterocolitis: risk factors and outcomes.Gastroenterol Res Pract. 2016 Jun;2016(1)1-6. doi:10.1155/2016/6134187Jin YT, Duan Y, Deng XK, Lin J.Prevention of necrotizing enterocolitis in premature infants - an updated review.World J Clin Pediatr. 2019 Apr;8(2):23-32. doi:10.5409/wjcp.v8.i2.23Herrmann K, Carroll K.An exclusively human milk diet reduces necrotizing enterocolitis.Breastfeed Med. 2014 May;9(4):184-190. doi:10.1089/bfm.2013.0121Diez S, Tielesch L, Weiss C, Halbfass J, Müller H, Besendörfer M.Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease.Front Pediatr. 2020 Jun;8(1):1-9. doi:10.3389/fped.2020.00257Eunice Kennedy Shriver National Institute of Child Health and Human Development.What are the symptoms of necrotizing enterocolitis (NEC)?.Cho SX, Rudloff I, Lao JC, et al.Characterization of the pathoimmunology of necrotizing enterocolitis reveals novel therapeutic opportunities.Nat Commun. 2020 Nov;11(1):1-19. doi:10.1038/s41467-020-19400-wFederici S, De Biagi L.Long term outcome of infants with NEC.Curr Pediatr Rev. 2019;15(2):111-114. doi:10.2174/1573396315666181130144925Prasad Verma R, Kota A.Necrotizing enterocolitis.Pediatric Surgery, Flowcharts and Clinical Algorithms. IntechOpen.Xiong T, Maheshwari A, Neu J, EI-Saie A, Pammi M.An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants.Neonatology. 2020 Apr;117(1):46-56. doi:10.1159/000504371Maffei D, Schanler R.Human milk is the feeding strategy to prevent necrotizing enterocolitis!.Semin Perinatol. 2017 Feb;41(1):36-40. doi:10.1053/j.semperi.2016.09.016Thomas J, Raine T, Reddy S, Belteki G.Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review.Acta Paediatr. 2017 Nov;106(11):1729-1741. doi:10.1111/apa.13902Additional ReadingBradshaw, MSN RN NNP-BC, CCRN Wanda Todd. “Necrotizing Enterocolitis: Etiology, Presentation, Management, and Outcomes.”The Journal of Perinatal & Neonatal Nursing23:87-94.Schurr, P and Perkins, EM. “The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants.”Neonatal Network27:397-407.

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alganabi M, Lee C, Bindi E, Li B, Pierro A.Recent advances in understanding necrotizing enterocolitis.F1000Res. 2019 Jan;8(1):1-8. doi:10.12688/f1000research.17228.1Yu L, Tian J, Zhao X, et al.Bowel perforation in premature infants with necrotizing enterocolitis: risk factors and outcomes.Gastroenterol Res Pract. 2016 Jun;2016(1)1-6. doi:10.1155/2016/6134187Jin YT, Duan Y, Deng XK, Lin J.Prevention of necrotizing enterocolitis in premature infants - an updated review.World J Clin Pediatr. 2019 Apr;8(2):23-32. doi:10.5409/wjcp.v8.i2.23Herrmann K, Carroll K.An exclusively human milk diet reduces necrotizing enterocolitis.Breastfeed Med. 2014 May;9(4):184-190. doi:10.1089/bfm.2013.0121Diez S, Tielesch L, Weiss C, Halbfass J, Müller H, Besendörfer M.Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease.Front Pediatr. 2020 Jun;8(1):1-9. doi:10.3389/fped.2020.00257Eunice Kennedy Shriver National Institute of Child Health and Human Development.What are the symptoms of necrotizing enterocolitis (NEC)?.Cho SX, Rudloff I, Lao JC, et al.Characterization of the pathoimmunology of necrotizing enterocolitis reveals novel therapeutic opportunities.Nat Commun. 2020 Nov;11(1):1-19. doi:10.1038/s41467-020-19400-wFederici S, De Biagi L.Long term outcome of infants with NEC.Curr Pediatr Rev. 2019;15(2):111-114. doi:10.2174/1573396315666181130144925Prasad Verma R, Kota A.Necrotizing enterocolitis.Pediatric Surgery, Flowcharts and Clinical Algorithms. IntechOpen.Xiong T, Maheshwari A, Neu J, EI-Saie A, Pammi M.An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants.Neonatology. 2020 Apr;117(1):46-56. doi:10.1159/000504371Maffei D, Schanler R.Human milk is the feeding strategy to prevent necrotizing enterocolitis!.Semin Perinatol. 2017 Feb;41(1):36-40. doi:10.1053/j.semperi.2016.09.016Thomas J, Raine T, Reddy S, Belteki G.Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review.Acta Paediatr. 2017 Nov;106(11):1729-1741. doi:10.1111/apa.13902Additional ReadingBradshaw, MSN RN NNP-BC, CCRN Wanda Todd. “Necrotizing Enterocolitis: Etiology, Presentation, Management, and Outcomes.”The Journal of Perinatal & Neonatal Nursing23:87-94.Schurr, P and Perkins, EM. “The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants.”Neonatal Network27:397-407.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Alganabi M, Lee C, Bindi E, Li B, Pierro A.Recent advances in understanding necrotizing enterocolitis.F1000Res. 2019 Jan;8(1):1-8. doi:10.12688/f1000research.17228.1Yu L, Tian J, Zhao X, et al.Bowel perforation in premature infants with necrotizing enterocolitis: risk factors and outcomes.Gastroenterol Res Pract. 2016 Jun;2016(1)1-6. doi:10.1155/2016/6134187Jin YT, Duan Y, Deng XK, Lin J.Prevention of necrotizing enterocolitis in premature infants - an updated review.World J Clin Pediatr. 2019 Apr;8(2):23-32. doi:10.5409/wjcp.v8.i2.23Herrmann K, Carroll K.An exclusively human milk diet reduces necrotizing enterocolitis.Breastfeed Med. 2014 May;9(4):184-190. doi:10.1089/bfm.2013.0121Diez S, Tielesch L, Weiss C, Halbfass J, Müller H, Besendörfer M.Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease.Front Pediatr. 2020 Jun;8(1):1-9. doi:10.3389/fped.2020.00257Eunice Kennedy Shriver National Institute of Child Health and Human Development.What are the symptoms of necrotizing enterocolitis (NEC)?.Cho SX, Rudloff I, Lao JC, et al.Characterization of the pathoimmunology of necrotizing enterocolitis reveals novel therapeutic opportunities.Nat Commun. 2020 Nov;11(1):1-19. doi:10.1038/s41467-020-19400-wFederici S, De Biagi L.Long term outcome of infants with NEC.Curr Pediatr Rev. 2019;15(2):111-114. doi:10.2174/1573396315666181130144925Prasad Verma R, Kota A.Necrotizing enterocolitis.Pediatric Surgery, Flowcharts and Clinical Algorithms. IntechOpen.Xiong T, Maheshwari A, Neu J, EI-Saie A, Pammi M.An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants.Neonatology. 2020 Apr;117(1):46-56. doi:10.1159/000504371Maffei D, Schanler R.Human milk is the feeding strategy to prevent necrotizing enterocolitis!.Semin Perinatol. 2017 Feb;41(1):36-40. doi:10.1053/j.semperi.2016.09.016Thomas J, Raine T, Reddy S, Belteki G.Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review.Acta Paediatr. 2017 Nov;106(11):1729-1741. doi:10.1111/apa.13902

Alganabi M, Lee C, Bindi E, Li B, Pierro A.Recent advances in understanding necrotizing enterocolitis.F1000Res. 2019 Jan;8(1):1-8. doi:10.12688/f1000research.17228.1

Yu L, Tian J, Zhao X, et al.Bowel perforation in premature infants with necrotizing enterocolitis: risk factors and outcomes.Gastroenterol Res Pract. 2016 Jun;2016(1)1-6. doi:10.1155/2016/6134187

Jin YT, Duan Y, Deng XK, Lin J.Prevention of necrotizing enterocolitis in premature infants - an updated review.World J Clin Pediatr. 2019 Apr;8(2):23-32. doi:10.5409/wjcp.v8.i2.23

Herrmann K, Carroll K.An exclusively human milk diet reduces necrotizing enterocolitis.Breastfeed Med. 2014 May;9(4):184-190. doi:10.1089/bfm.2013.0121

Diez S, Tielesch L, Weiss C, Halbfass J, Müller H, Besendörfer M.Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease.Front Pediatr. 2020 Jun;8(1):1-9. doi:10.3389/fped.2020.00257

Eunice Kennedy Shriver National Institute of Child Health and Human Development.What are the symptoms of necrotizing enterocolitis (NEC)?.

Cho SX, Rudloff I, Lao JC, et al.Characterization of the pathoimmunology of necrotizing enterocolitis reveals novel therapeutic opportunities.Nat Commun. 2020 Nov;11(1):1-19. doi:10.1038/s41467-020-19400-w

Federici S, De Biagi L.Long term outcome of infants with NEC.Curr Pediatr Rev. 2019;15(2):111-114. doi:10.2174/1573396315666181130144925

Prasad Verma R, Kota A.Necrotizing enterocolitis.Pediatric Surgery, Flowcharts and Clinical Algorithms. IntechOpen.

Xiong T, Maheshwari A, Neu J, EI-Saie A, Pammi M.An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants.Neonatology. 2020 Apr;117(1):46-56. doi:10.1159/000504371

Maffei D, Schanler R.Human milk is the feeding strategy to prevent necrotizing enterocolitis!.Semin Perinatol. 2017 Feb;41(1):36-40. doi:10.1053/j.semperi.2016.09.016

Thomas J, Raine T, Reddy S, Belteki G.Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review.Acta Paediatr. 2017 Nov;106(11):1729-1741. doi:10.1111/apa.13902

Bradshaw, MSN RN NNP-BC, CCRN Wanda Todd. “Necrotizing Enterocolitis: Etiology, Presentation, Management, and Outcomes.”The Journal of Perinatal & Neonatal Nursing23:87-94.Schurr, P and Perkins, EM. “The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants.”Neonatal Network27:397-407.

Bradshaw, MSN RN NNP-BC, CCRN Wanda Todd. “Necrotizing Enterocolitis: Etiology, Presentation, Management, and Outcomes.”The Journal of Perinatal & Neonatal Nursing23:87-94.

Schurr, P and Perkins, EM. “The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants.”Neonatal Network27:397-407.

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