NEC (Necrotizing Enterocolitis) is a serious and potentially life-threatening condition that affects the intestines of premature infants, with mortality rates as high as 50 percent. According to Cleveland Clinic, this condition is rare and affects 1 in every 1,000 premature babies. The risk is greatest for those weighing less than 2 pounds at birth.
The exact causes of NEC are not well understood, but several risk factors have been identified, including:
- Prematurity: NEC occurs primarily in premature infants, especially those born before 32 weeks of gestation.
- Immature gut: The gut of a premature infant is more susceptible to injury and infection than that of a full-term infant.
- Bacterial infection: NEC is thought to be caused by a bacterial infection in the gut, although the specific bacteria involved are not well understood.
- Feeding: Giving premature infants formula-based milk instead of breastmilk before their gut is mature enough to handle it may increase the risk of NEC as formula-based milk is not digested easily as human milk.
If your child received the baby bovine-based formula from a hospital or was given it as a gift, and later developed necrotizing enterocolitis, then you can file an NEC Baby Formula Lawsuit to hold the concerned authorities accountable.
All those are potential causes of NEC, but it’s not known yet what is the main cause or causes. Research is still ongoing to understand the disease better.
The treatment options for necrotizing enterocolitis in children include:
Conservative management is a treatment approach for Necrotizing Enterocolitis (NEC) that aims to stabilize the infant’s condition without the need for surgery. The main components of conservative management for NEC include:
- Stopping feeds: Feeding is usually stopped for a period of time to allow the gut to rest and heal.
- Intensive care: The infant is closely monitored in the neonatal intensive care unit (NICU) for signs of deterioration and to ensure that the conservative management approach is working.
- Antibiotics: Antibiotics are given to help fight the bacterial infection that is thought to play a role in developing NEC.
In some cases of NEC, conservative management may be successful in resolving the condition, avoiding the need for surgery. However, in cases where the NEC is more severe or not responding to conservative management, surgery may be necessary to remove necrotic (dead) tissue and preserve healthy intestinal tissue.
The primary goal of medical management for NEC is to control inflammation and infection while providing supportive care to help the infant recover. The common medical treatments are:
- Intravenous antibiotics, to control bacterial infection and reduce inflammation in the gut.
- Gastrostomy or jejunostomy tube, to provide a way to give nutrition directly to the stomach or small intestine if the infant is unable to feed by mouth.
- Steroids ─ They have been used to reduce gut inflammation and improve blood flow to the affected area.
- Surgery ─ in severe cases, surgery may be necessary to remove dead or dying tissue and restore blood flow to the affected area.
Close monitoring of vital signs, electrolytes, blood gasses, and stool output is crucial to evaluate the progression of the disease and adjusting the management.
This includes the use of antibiotics to help fight infection and medications such as steroids to help reduce inflammation.
Surgical management of NEC in infants is typically considered when conservative medical treatment measures have failed or if there is a lack of improvement with the use of antibiotics and other medical therapies and there is evidence of ischemia and necrosis. The main goal of surgery is to remove necrotic tissue, control sepsis, and restore the continuity and function of the intestine.
There are several surgical options for NEC, which include:
- Laparotomy: An open surgical procedure to remove necrotic tissue. It allows the surgeon to directly visualize and remove the affected tissue and to perform a primary anastomosis (reconnection of the intestine) if possible.
- Peritoneal drainage: In cases where there is a localized area of necrosis, a catheter is placed through the abdominal wall and into the affected area to remove fluid and gas and allow the area to heal.
- Strictureplasty: This is a procedure that involves widening a narrowed segment of the intestine and can be done in combination with laparotomy.
- Bowel resection: If a large segment of the bowel is affected or a strictureplasty is not possible, resection of the necrotic bowel segment may be required. The remaining healthy segments are then connected together.
It is important to note that surgery carries risks, including bleeding, infection, and the need for additional procedures. After surgery, close monitoring is essential to assess for complications and evaluate the healing process.
Postoperative management includes antibiotics, fluid and nutritional support, and careful monitoring of the infant’s vital signs, electrolytes, blood gases, and stool output.
The outcomes after surgical treatment for NEC can vary depending on the extent of the necrosis and the time to diagnosis and intervention. Early diagnosis and prompt treatment improve the chance of recovery and minimal morbidity.
Nutritional support is an important aspect of treating NEC in infants. Necrotizing Enterocolitis affects the ability of the gut to absorb nutrients and can lead to malnutrition, which can complicate recovery.
There are several options for providing nutritional support to infants with NEC:
- Parenteral nutrition (PN): This involves providing nutrition through a vein (intravenous), it is usually used in the early stages of NEC, when the infant is unable to tolerate enteral feeds and the gut needs to rest and recover.
- Enteral nutrition: This involves providing nutrition through a tube (such as nasogastric or gastrostomy tube) that goes into the stomach or small intestine, It is typically used once the infant is able to tolerate enteral feeds and the gut has started to recover.
- Human Milk: Human milk is the ideal nutrition for premature infants. It has a lot of benefits that can support their gut recovery, decrease the risk of NEC, and improve overall outcomes.
The choice of nutritional support is determined by the severity of NEC and the infant’s clinical condition.
It is important to note that close monitoring of an infant’s weight, growth, and nutritional status is critical during the recovery process. Also, the goal of nutritional support is to provide adequate nutrition to support the healing process and meet the infant’s growth and development needs.
It’s worth noting that treatment plans are often tailored to the individual patient and their specific needs, so the approach used may vary depending on the case.