What are the symptoms of necrotizing enterocolitis (NEC)?

In NEC, some of the tissue lining an infant’s intestine becomes diseased and can die. The bacteria in the infant’s intestine can then penetrate the dead or decaying intestinal tissue, infect the wall of the intestine, and enter the bloodstream, causing systemic or bloodstream infection. The surviving tissue becomes swollen and inflamed; as a result, the infant is unable to digest food or otherwise move food through the digestive tract.¹

The symptoms of NEC can develop over a period of days or appear suddenly. Commonly reported symptoms include^2,3:

• Poor tolerance of feeding (not being able to digest food)
• Bloating or swelling of the stomach (abdominal distention)
• Stomach discoloration, usually bluish or reddish
• Pain when someone touches the abdomen
• Blood in the stools or a change in their volume or frequency
• Diarrhea, with change in the color and consistency of the stool, often containing frank (visible) blood
• Decreased activity (lethargy)
• Vomiting greenish-yellow liquid
• Inability to maintain normal temperature
• Episodes of low heart rate or apnea, a temporary stop in breathing
• In advanced cases, the blood pressure may drop and the pulse may become weak. Infants may develop fluid in the abdominal cavity or infection of the tissue lining the stomach (a condition called peritonitis), or they could go into shock.³ The affected area of the intestine may develop a hole or perforation in the wall requiring emergency surgery.^2,3 Pressure from the abdomen can cause a severe difficulty in breathing. In this case, the infant may need support from a breathing machine, or respirator.