Other Necrotizing Enterocolitis (NEC) FAQs

The most definitive step toward preventing NEC is to prevent preterm birth. However, some experts believe that the following steps have been shown to reduce the risk for NEC among those who are born preterm.

• Early feeding with colostrum/human milk. Because the colostrum and mother’s milk contain many protective elements, even small quantities of a baby’s mother’s colostrum or early breast milk may have some protective effect.
• Avoiding gut starvation. Health care teams are mindful that feeding practices contribute to infant health. If an infant is very ill, they may need to withhold feedings because digestion is difficult. However, prolonged starvation is a risk factor for NEC, and therefore, early, small amounts of feeding are considered protective.
• Some reports indicate that prophylactic use of probiotics can help prevent NEC. However, no definitive studies have been conducted in the United States on probiotic use, and thus far, probiotics are not approved for use in sick newborn infants.

In full-term infants more often than in preterm infants, NEC is associated with congenital heart disease. Some researchers consider this type of NEC to be different from other types because infants who have NEC along with congenital heart disease have less of a chance of developing a hole in their intestine, which would require surgery. Thus the name “cardiogenic NEC,” or NEC that stems from heart problems, has been suggested for this disease.¹

Other conditions that can predispose a full-term infant to NEC include severe asphyxia (lack of oxygen) suffered before, during, or immediately after birth and a condition known as polycythemia, in which the infant has higher than normal amount of red blood cells expressed as “hematocrit.” Healthy infants have a hematocrit value between 45% and 65%. In infants with polycythemia, the hematocrit value is higher than 65%. Bursting of the intestine, which leads to a hole in its wall (called a perforation), as a result of infection and local tissue damage is the most serious complication of NEC. Removing the severely damaged or dead segment of the intestine is a major surgical procedure. Surgeons will hook the cut ends of the intestines to the abdominal wall, also known as an ostomy, until all signs of intestinal infection are healed. Later, in a second surgical procedure, the intestines are reconnected.²

Areas of the intestine that were damaged from NEC may develop scar tissue, known as stricture. This can cause the intestine to narrow, making it difficult for bowel contents to pass through. Dilation or surgery of the intestine may be necessary.

A serious residual complication of removing dead and damaged intestine is called "short-gut syndrome." This syndrome causes problems with digestion if long portions of the small intestine that absorb nutrition have been removed. As the child gets older (over a span of 2 to 3 years), this digestive problem may improve. If it does not, it can cause under-nutrition, requiring prolonged nutritional support using intravenous routes. The latter can lead to liver failure. If the digestive problems do not resolve, infants with this complication may need a liver transplant and/or a small-bowel transplant.³

Other possible complications of NEC include²:

• Partial or complete blockage of the intestine due to abnormal tissue growth or scar tissue.
• Infection of the tissue lining the stomach (called peritonitis).
• Sepsis, a severe reaction of the child's body to infection.