What Happens in Necrotizing Enterocolitis & When Can The Baby Suffering From Necrotizing Enterocolitis Start On Normal Feedings?

What is Necrotizing Enterocolitis?(1,2)

Necrotizing enterocolitis is a serious and commonly occurring intestinal disease in babies who have been born prematurely. Necrotizing enterocolitis develops when there is inflammation or injury in the tissue of the large or small intestine leading to death of the intestinal tissue and sometimes also causing a perforation in the wall of the intestine.

What Happens in Necrotizing Enterocolitis?(1,2)

When suffering from Necrotizing Enterocolitis, the intestine loses its ability to contain waste. This causes the bacteria to enter into the blood, which can result in a fatal infection. There is also leakage of waste products into the abdomen of the baby causing illness. The injured or damaged parts of the intestine die or get necrosed, which needs to be surgically removed.

Causes of Necrotizing Enterocolitis(1,2)

A specific cause of necrotizing enterocolitis is yet to be discovered. Some of the things that can potentially cause necrotizing enterocolitis are:

  • Very less blood flow or oxygen to the intestine when the baby is born or later in the life.
  • Having an underdeveloped intestine.
  • Acute bacterial growth in the intestine, which causes erosion of the walls of the intestine.
  • Any injury or damage to the lining of the intestine.
  • Bacterial or viral infection of the intestine.

Risk Factors for Necrotizing Enterocolitis(1)

Babies that are born before 32 weeks of gestation are at higher risk for necrotizing enterocolitis. However, full-term babies suffering from health issues, such as a heart defect, can also have necrotizing enterocolitis. Babies with necrotizing enterocolitis often develop this condition in the initial 2 to 4 weeks of their life.

Signs & Symptoms of Necrotizing Enterocolitis(1,2)

The symptoms of necrotizing enterocolitis differ from baby to baby and resemble the symptoms caused by any digestive issues. Some of the common symptoms in a baby suffering from necrotizing enterocolitis are:

  • Difficulty feeding.
  • A belly that is red, swollen and tender.
  • Food stays in the stomach for a long time.
  • Dark or bloody stools/diarrhea.
  • Constipation can also occur.
  • The baby is lethargic.
  • The baby has a green vomit, which has bile in it.
  • The baby has unstable or low body temperature.
  • The baby suffers from apnea where the breathing pauses temporarily.
  • The baby also has bradycardia where the heart rate is slower than normal.
  • The baby is hypotensive.

Spreading of Necrotizing Enterocolitis

Necrotizing enterocolitis seems to develop in “clusters,” where several babies from a same nursery are affected with this condition. Although this can be a coincidence; however, there are some bacteria and viruses that are found in babies suffering from necrotizing enterocolitis. Necrotizing enterocolitis cannot spread from one infant to another; however, its causative pathogen can pass from one to another.

Diagnosis of Necrotizing Enterocolitis(1,2)

Diagnosis of necrotizing enterocolitis can be confirmed by doing an x-ray where an abnormal gas pattern can be seen, which resembles a streaky or bubbly appearance of gas in the intestinal walls.

X-ray done in severe cases of necrotizing enterocolitis where there is release of the air from the intestine, shows up in the abdominal cavity or large veins of the liver. To check if there is a hole in the intestine, the doctor inserts a needle into the abdomen to withdraw fluid.

Treatment of Necrotizing Enterocolitis(1,2)

Treatment is started as soon as the diagnosis of necrotizing enterocolitis is confirmed or made and it consists of:

  • Stopping all the feedings temporarily.
  • Intravenous fluids for replacement of fluid and nutrition to the baby are started.
  • Orogastric or nasogastric drainage is done where a tube is inserted via the mouth or into the stomach so that the fluid and air can be removed from the intestine and stomach.
  • Antibiotics are given to prevent or treat infection.
  • Exams and abdominal x-rays are done to monitor the condition.
  • A pediatric consultation is done as severe cases of necrotizing enterocolitis need immediate surgery.

The baby’s belly size is regularly checked and its poop is observed for presence of blood. If there is any intestinal perforation or abdominal infection, then it will cause swelling of the baby’s belly. If this swollen belly hampers the breathing of the baby, then extra oxygen or a ventilator is needed to help the baby breathe. Other than this, blood tests are done to check if the baby has anemia or any bacteria present in the blood.

When Can The Baby Suffering From Necrotizing Enterocolitis Start On Normal Feedings?

As soon as the baby responds to the treatment, regular feedings can be resumed in a couple of weeks. Breast milk is highly recommended, as it is beneficial for babies; especially ones suffering from necrotizing enterocolitis because of its capability to get easily digested and breast milk also contributes to the healthy bacterial growth in the intestinal tract, which strengthens the immunity of the baby. A strong immunity is extremely important for babies born prematurely.

If the mother is not able to breastfeed, then it is recommended to give the baby pasteurized human breast milk taken from a milk bank. Use of a special formula can also be done.

Is Surgery Needed In Necrotizing Enterocolitis?(1,2)

If necrotizing enterocolitis worsens, then the baby will require surgery where the pediatric surgeon will look for a perforation in the intestine and excise any necrotic intestinal tissue. Sometimes, after the removal of the dead intestine, the healthy parts of the intestine can be sewn back together. In some cases, if a large part of the intestine has been removed or if the baby is extremely ill, then an ostomy is done. Sometimes, a second surgery is done to re-assess the intestines. The ostomy will be closed about 6 to 8 weeks later after the surgeon is satisfied that the intestine has completely healed and is healthy and functioning.

Prognosis of Necrotizing Enterocolitis(1,2)

Most of the babies suffering from necrotizing enterocolitis fully recover and do not suffer from any additional feeding problems. Additional surgery is only needed if the intestine has been narrowed, scarred or blocked. The death rate from necrotizing enterocolitis ranges from 10 to 50%.

One of the lasting problems from necrotizing enterocolitis is malabsorption where there is difficulty in absorption of nutrients by the intestine.(2) This is more common in babies who had removal of a part of their intestine. In such cases of malabsorption, nutrition is provided directly via a vein till complete healing of intestine occurs, such that normal feedings can be tolerated.

Conclusion

As necrotizing enterocolitis is a serious condition, it is normal for the parents to worry. Not feeding the baby can also be quite frustrating for the parents. The thing to keep in mind is not feeding the baby is part of the treatment of necrotizing enterocolitis and as soon as the baby responds to treatment, you can start feeding the baby. You can also seek support from the care team who help the parents in bonding with their preemies on the path to recovery.

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