Carenotes > Necrotizing Enterocolitis In Children

Necrotizing Enterocolitis In Children

GENERAL INFORMATION:

What is necrotizing enterocolitis?

• Necrotizing (NEK-ro-TIZ-ing) enterocolitis (EN-ter-o-ko-LI-tis), also known as NEC, is a serious intestinal disease that usually affects premature infants. This often occurs within the first 2 weeks of birth and after milk feeding has started. With NEC, the intestines (bowels) get infected and inflamed (swollen). This causes damage and necrosis (tissue death) of a part or of the entire intestines. Over time, this necrosis may prevent blood flow through the intestines causing pain, perforation (a hole), or bleeding.
  
  
• The intestines are part of the gastrointestinal (GI) system where food is digested (broken down). The small intestine is the tube that runs from the stomach to the colon (large intestine). The colon is the long tube that connects the small bowel with the anus (rear end). The colon absorbs water from digested foods and turns the digested food into stool (bowel movement). It also stores the stool until it can be passed out through your anus.

What causes necrotizing enterocolitis? The exact cause of necrotizing enterocolitis remains unclear. The intestines are thought to be affected before or after your baby's birth. The following are possible factors that may cause NEC:

• Prematurity: Babies delivered early (before the 37th week of pregnancy) or who have low birth weights usually have immature bowels. These immature bowels may not work well and are more likely to get infected.
  
  
• Low oxygen or blood supply: Too little oxygen or blood flow may damage and weaken the intestines, such as with a difficult delivery. Oxygen and blood, meant to go to the intestines, is instead sent to vital organs, such as the heart, lungs, or brain. Low oxygen supply may also be caused by certain blood, heart, and lung diseases.
  
  
• Milk feeding: The concentration of the milk formula and how fast it was given may add stress to the intestines. Intestinal bacteria may then easily invade and damage the overworked intestines.
  
  
• Infections: Germs, such as bacteria, may easily damage immature intestines. It is also possible that NEC may spread from one infected baby to another. This happens when an outbreak occurs in a nursery.

What are the signs and symptoms of necrotizing enterocolitis? Your baby may have one or more of the following:

• Abdominal (belly) pain or enlargement.
  
  
• Blood in the stool or greenish vomit (throw-up).
  
  
• Breathing problems, such as apnea (breathing stops for more than 20 seconds).
  
  
• Extreme changes in body temperature.
  
  
• Frequent crying, fussiness, or lethargy (sleeps more than usual and hardly wakes up).
  
  
• Hypotension (low blood pressure).
  
  
• Poor sucking or feeding problems.

What problems can necrotizing enterocolitis cause? With NEC, your baby's intestines are not working well. He may not be able to absorb enough milk, food, and nutrients needed by his body. The following are problems that may be caused by NEC:

• Bleeding: Blood vessels in the intestines may weaken and burst. This may cause blood to be seen in your baby's stool.
  
  
• Bowel obstruction: The infection in your baby's intestines may form a scar and cause narrowing of the bowel. This may lead to a partial or complete blockage of his bowel.
  
  
• Fistula: A fistula is an abnormal connection between two organs or between an organ and the skin. This forms when damaged tissues stick together during an infection.
  
  
• Perforation: Small holes or tears cause pus or bowel contents to leak out of the intestines into the abdomen.
  
  
• Peritonitis: This occurs when infection spreads outside the intestines into the wall of the abdomen. Sepsis (blood infection) may follow soon afterwards.

How is necrotizing enterocolitis diagnosed? Your baby may need one or more of the following tests:

• Abdominal x-rays: These are pictures of the organs inside your child's abdomen. Caregivers use these pictures to look for problems, such as blocked intestines. These may also check for the presence of air in his bowels or large veins in the liver. Air outside the intestines and in the abdominal cavity may also be seen with these x-rays.
  
  
• Blood tests: Different blood tests may be done to your baby to check for infections.
  
  
• Stool test: A sample of your baby's stool (BM) may also be taken and sent to a lab for tests.

How is necrotizing enterocolitis treated? Caregivers may stop feeding your baby through his mouth. A tube may be inserted into your baby's nose or mouth and down to his stomach. This tube, called a gastric tube, helps to keep air and fluid out of his belly. It may help if he throws up a lot and may be used to give him food and medicine. He may also need one or more of the following:

• IV: An IV is a tiny tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.
    
    
  • Pain medicine: Caregivers may give medicine to decrease your child's pain. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.
    
    
  • Special milk formulas and vitamins: These may be given through the gastric tube to make sure your baby is getting the proper nutrition. Other special formulas that have fats and oils, which are easy to digest, may also be given.
  
  
• Surgery: Your baby may need surgery if the intestines have tears or holes. Caregivers may also remove a part of or the entire bowel. If stool spills from his bowel, a colostomy may be done. Colostomy is a surgery where part of the intestines are connected to an opening on the abdomen. The intestines may be connected back when the infection and swelling have healed. Sometimes, your baby may need a bowel transplant. This is done by removing your baby's bowel and replacing it with a healthy, donated bowel.

With treatment, such as medicine and surgery, your baby's symptoms may be relieved and his quality of life may be improved.

Where can I get more information? Accepting that your baby has necrotizing enterocolitis may be hard. You, your family, and those close to you may feel scared, sad, or angry. These are normal feelings. Talk to your baby's caregivers, your family, or friends about your feelings. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village, IL 60007-1098
  Phone: 1-847-434-4000
  Web Address: http://www.aap.org
  

CARE AGREEMENT:

You have the right to help plan your baby's care. To help with this plan, you must learn about your baby's health condition and how it may be treated. You can then discuss treatment options with your baby's caregivers. Work with them to decide what care may be used to treat your baby.

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