Necrotizing Enterocolitis (NEC)

Research suggests several factors may contribute to the pathogenesis of NEC in preterm infants. These factors include:

• An immature intestinal epithelium with a leaky intestinal barrier
• Propensity towards intestinal inflammation
• Abnormal gut bacterial colonization (termed dysbiosis)   

Presentation can be varied for individual infants, but may include:

• Feeding intolerance, including emesis
• Abdominal distension and/or tenderness
• Bloody stools
• Lethargy 

Diagnosis typically involves abdominal imaging such as one or more abdominal radiographs. Diagnosis may be uncertain and be made over time with serial abdominal imaging.  There are currently no FDA approved diagnostic tests (e.g. biomarkers) for NEC . 

Treatment for NEC may include stopping feedings (e.g. NPO) to provide bowel rest, providing intravenous nutrition and administration of antibiotics. In severe cases, surgery may be necessary to remove areas of intestinal necrosis. This may require transfer of an infant to a higher level of NICU care with pediatric surgical consultation available.  

Provision of mother’s own milk for hospitalized very low birth weight (VLBW) infants provides short- and long-term health benefits. Mother’s own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Pasteurized donor milk feeding is recommended for VLBW infants when mother’s own milk is not available, is insufficient, or is contraindicated. Infants fed mother’s own milk or pasteurized donor human milk may still develop NEC.  

Clinicians can assist parents who have given birth to preterm and other vulnerable infants to establish a full supply of milk by working with hospital staff to facilitate early, frequent milk expression.  

A pharmaceutical-grade probiotic product for preterm infants is not currently available in the United States.  

The long-term outlook for infants who develop NEC varies. Some infants may recover fully with medical treatment and experience no long-term effects, while others may die or experience long-term complications such as short bowel syndrome or neurodevelopmental impairment. Because infants with NEC, particularly those that need surgery, can have long-term complications, close follow-up is important. Follow-up may include pediatrics specialists that can include surgeons, developmental specialists and gastroenterologists.