Was your baby born prematurely? We know how scary and anxious a mother or father can be when they have a premature baby. Especially if the baby is in the NICU ( Neonatal Intensive Care Unit), that feeling is even greater. When the doctor suddenly comes in and tells you that your baby has a serious intestinal problem, a condition called NEC (Necrotizing Enterocolitis), it is difficult to put into words what it feels like. Today we are talking about this condition called NEC, which many mothers and fathers fear, but which is very important to be aware of.
Simply put, what is this NEC?
Necrotizing Enterocolitis (NEC) is a very serious digestive disease that mainly affects premature babies. In this case, the tissues of the baby's intestine become damaged, swollen, and begin to die. The word "necrotizing" means "tissue death." "Enterocolitis" means inflammation of the intestine.
Think about it, our intestines are not just a tube. They are a complex organ made of living tissue that helps digest food and absorb nutrients. In NEC, the wall of this intestine becomes weak, damaged, and sometimes even perforated . If such a hole forms, germs, such as bacteria, that are inside the intestine can get into the baby's abdomen or blood. This is a very dangerous condition.
NEC usually occurs between two and six weeks after birth. In some babies, it is very mild and gets better. In others, it can be severe and life-threatening.
Who is most at risk of developing this condition?
Of the 10 babies who develop NEC, 9 are premature babies . It is very rare for babies born at full term to develop it. The following are at highest risk:
- Babies born before 37 weeks of pregnancy: The risk is especially high for babies born before 32 weeks.
- Very low birth weight babies: Babies weighing less than 2.5 kilograms (5.5 pounds) at birth are at particularly high risk. Babies weighing less than 1 kilogram (2.2 pounds) are at particularly high risk.
- For babies fed through a tube (enteral nutrition): Because premature babies have a reduced ability to suck, milk is given through a tube inserted through the nose into the stomach.
- For babies who had complications at birth: For example, babies who had problems such as breathing difficulties or heart disease.
About one in 1,000 premature babies develop NEC. However, this condition occurs in about one in 10,000 full-term babies. So it is accurate to say that this is mainly a disease of premature babies.
What are the main types of NECs?
Doctors divide this disease into several types, depending on the time the symptoms begin and the cause of the disease.
| NEC type | Description |
|---|---|
| Classic NEC (most commonly seen type) | This is the most common type. It usually occurs in babies born before 28 weeks of pregnancy. It usually appears between 3 and 6 weeks after the baby is born. Most often, it starts suddenly, without any warning , after the baby is well and stable. |
| Transfusion-associated NEC (type associated with blood transfusion) | Some premature babies need blood transfusions because they are anemic. Some babies (about one in three) can develop NEC within three days of receiving this type of blood transfusion. |
| Atypical NEC (unusual type) | Very rarely, NEC can develop within the first week of birth or even before the baby is breastfed for the first time. |
| Term infant NEC (type of full-term infants) | If a full-term baby develops NEC, it is often caused by another problem that was present at birth. For example, a congenital heart condition, a condition where the intestines are outside the body (gastroschisis), or a lack of oxygen at birth. |
Sometimes, there have been reports of multiple babies developing NEC at the same time in the NICU ( Neonatal Intensive Care Unit). In such cases, the cause may be a bacterial infection such as E. Coli.
Why does this NEC occur? What is the cause?
In fact, doctors still haven't found a single cause for NEC. It's believed to be a combination of several factors.
The main points are:
1. Immature intestines: A premature baby's intestines are not yet fully developed. They are very delicate and weak. Therefore, they have difficulty with the digestion process.
2. Weak immune system: The immune system that fights diseases in premature babies is not fully developed. Therefore, even a small infection in the intestines can be difficult for the body to fight against.
3. Reduced blood flow to the intestines: The circulatory system of premature babies prioritizes sending blood to vital organs like the brain and heart. In times of stress (e.g., lack of oxygen), the body reduces the amount of blood flowing to the intestines. When blood flow is reduced, the tissues in the intestines do not receive the oxygen they need. As a result, those tissues become damaged and begin to die.
When these factors combine, the intestinal wall becomes weak, allowing bacteria to grow there, causing inflammation and leading to NEC.
What are the symptoms of NEC?
Doctors and nurses constantly monitor a baby in the NICU. So, even if they see the slightest sign of NEC, they act quickly. As a parent, it's important for you to be aware of these signs.
Symptoms may appear gradually over several days, or they may appear suddenly in a baby who has been well.
- Abdominal swelling and pain: The baby's stomach feels hard when touched, the baby cries when placed on it, and the stomach looks full.
- Refusal to drink milk: A baby who has been drinking well suddenly refuses to drink milk, leaving gastric residuals.
- Vomiting: Vomiting, especially green or yellow, may be a sign of a bowel obstruction.
- Changes in bowel movements: Changes in bowel movements, diarrhea-like stools, and blood in the stool .
- Change in general health status:
- The baby's heart rate slows down or increases.
- The breathing rate changes, sometimes stopping breathing for a moment (apnea).
- Blood pressure drops.
- Body temperature cannot be maintained.
- The baby is very lethargic and seems lifeless.
If one or more of these symptoms are seen, the NICU staff will immediately investigate.
How do doctors find this?
The first thing your baby's doctor will do is examine your baby carefully. They will check for swelling and tenderness. They will also run a few tests to confirm the diagnosis.
- Abdominal X-ray: This is the most important test. It can check for gas bubbles in the intestinal wall. This is called `pneumatosis intestinalis`. Also, if the intestine is perforated, free air can be seen in the abdominal cavity.
- Blood tests: These check for infections (bacteria) in the blood, low white blood cell counts, and blood clotting problems.
- Fecal test: This test helps detect blood in the stool that is not visible to the eye.
What are the possible complications of NEC?
Because NEC is a serious condition, complications can occur after it.
- Peritonitis: If there is a hole in the intestine, bacteria can enter the abdominal cavity and cause a severe infection (peritonitis). This can lead to a life-threatening condition called sepsis , in which the bacteria spread throughout the body.
- Intestinal Stricture: After NEC has healed, the damaged part of the intestine can become scarred and narrowed as it heals. This makes it difficult to eat. This may require surgery at a later date.
- Short Bowel Syndrome: If a large part of the intestine dies due to NEC and has to be surgically removed, the remaining part of the intestine is not enough to absorb nutrients properly. This condition is called short bowel (short gut) syndrome . Babies with this condition will need special attention to nutrition throughout their lives.
- Growth and Developmental Delays: Babies who have had NEC, especially those who have undergone surgery, may experience some delays in growth and brain development later in life. Therefore, it is very important to keep these babies under continuous medical supervision.
How is it treated?
As soon as NEC is suspected, doctors begin treatment. The main goal is to give the intestine complete rest .
1. Stop breastfeeding: The first thing to do is to completely stop feeding the baby by mouth or tube. This will give the intestines a rest and begin to heal.
2. IV Nutrition: All the nutrition and fluids the baby needs are provided through saline (IV fluids) given directly into a vein.
3. Nasogastric tube placement: A tube (nasogastric tube) is inserted through the nose into the stomach, draining air and fluids that have accumulated in the stomach. This reduces swelling in the stomach and relieves pressure on the intestines.
4. Antibiotics: To fight infection and prevent the spread of infection, strong antibiotics are given intravenously.
5. Constant monitoring: The baby is monitored very closely. Regular blood tests and X-rays are done to see if the condition is improving or worsening.
When is surgery necessary?
About one in four babies may need surgery. Surgery is done to:
- If it is confirmed that there is a perforation in the intestine.
- If the baby's condition does not improve with drug treatment.
During the operation, the surgeon removes the dead part of the intestine and reconnects the two healthy parts of the intestine. Sometimes, if the intestine is very swollen, it is difficult to reconnect it immediately. In such cases, a surgery called an ostomy is performed.
In an ostomy, one end of the healthy intestine is connected to a small opening (stoma) made in the skin of the baby's abdomen. The stool then comes out of the opening and collects in a small bag attached to it. This is temporary. After the baby's condition improves, another operation is performed to reconnect the two parts of the intestine inside the body.
If the baby is too small or too sick to undergo surgery, the doctor may place a small tube (drain) in the abdomen to drain the infected fluid and air that has accumulated in the abdominal cavity. This will relieve the symptoms. Later, when the baby is a little older and healthier, the surgery will be performed.
What is the future of a baby with NEC?
Although NEC is a scary disease, it is treatable. 8 out of 10 babies who develop NEC survive. While some of these babies may develop long-term health problems, most go on to live normal, full lives.
Are there ways to prevent this?
Although it cannot be completely prevented, there are several things you can do to reduce the risk of NEC.
- Preventing premature birth: It is best to keep the baby in the womb for as long as possible. To do this, follow proper medical advice during pregnancy.
- Corticosteroid injections: Doctors give mothers who are at risk of premature birth an injection called a corticosteroid. This helps the baby's lungs and intestines develop.
- Breastfeeding: Breastfeeding is the best protection for a premature baby. Breast milk has an amazing ability to reduce the risk of NEC. The immune-boosting components in breast milk protect the baby's gut.
- Probiotics: Some studies have shown that adding probiotics (good bacteria) to breast milk or formula may reduce the risk of NEC. However, you should definitely talk to your baby's doctor before doing this.
It can be a shock for parents to have a setback like NEC while their baby is in the NICU. But remember, the doctors and nurses in the NICU are specially trained to recognize and treat these conditions quickly. Trust them. Talk to them about any questions or concerns you may have.
Take-Home Message
- NEC (Necrotizing Enterocolitis) is a serious condition that mainly affects premature babies and causes the death of intestinal tissue.
- Be very careful about symptoms such as abdominal bloating, green vomit, aversion to milk, and blood in the stool.
- Breast milk is the best thing you can give a premature baby to protect them from NEC.
- There are treatments for this disease. Resting the bowel and giving antibiotics are the main treatments. Some babies may need surgery.
- Trust your baby's medical team in the NICU. They are trained to manage this condition.
- Even after recovery from NEC, it is important to continue to follow up with your doctor about your baby's growth and development.
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