Definition: An acquired disease, primarily in premature infants or sick newborns, in which intestinal tissue dies.
Causes, incidence, and risk factors: In necrotizing enterocolitis, the lining of the intestinal wall dies and the tissue sloughs off. The cause for this disorder is unknown, but it is thought that a decreased blood flow to the bowel keeps the bowel from producing the normal protective mucus. Bacteria in the intestine may also be a causative factor. Risk factors include small, premature infants, outbreaks among other infants in a nursery (suggesting an infectious cause), the feeding of concentrated formulas, and infants who have received blood exchange transfusions.
Prevention: Avoid feeding concentrated formula. Many cases are not preventable.
Symptoms: abdominal distention, vomiting and feeding intolerance, blood in the stool (visible or microscopic), lethargy, temperature instability, and diarrhea.
Treatment: In an infant with suspected necrotizing enterocolitis, feedings are stopped and the bowel is decompressed of gas by inserting a small tube into the stomach. Intravenous fluid is started to replace feedings of formula or breast milk. Antibiotic therapy is started. The infant's condition is monitored with abdominal X-rays, blood tests, and blood gases.
If intestinal perforation (hole) or peritonitis (inflammation of the abdominal wall) develop, surgery is indicated. The dead bowel tissue is removed and a colostomy or ileostomy is performed. The bowel is then reconnected several weeks or months later when the infection and inflammation have healed.
Expectations (prognosis): Necrotizing enterocolitis is a serious disease with a death rate of over 30%. The outcome is improved by aggressive, early treatment.
Complications: intestinal perforation, sepsis, peritonitis, and intestinal stricture (a narrow area that may lead to bowel obstruction).
Last updated May 25, 1999
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