Necrotizing enterocolitis (NEC) is a dangerous hemorrhagic inflammation of the intestinal wall that most often affects premature infants. Typical symptoms include abdominal distension, gastric retention, tenderness, rectal bleeding, and visible intestinal loops lacking peristalsis. A radiographic finding of gas within the wall of the intestine (pneumatosis intestinalis) confirms the suspected diagnosis. Conservative management of the condition involves parenteral nutrition and antibiotics. In the case of advanced NEC and intestinal perforation, however, surgery is necessary.
- NEC is the most common cause of acute abdomen in premature infants.
- Peak incidence: 2nd–4th week after birth (not during the first week!)
Epidemiological data refers to the US, unless otherwise specified.
- The causes of necrotizing enterocolitis are not fully understood but multiple factors contribute to the development of the condition.
|Bell staging criteria|
|Stage I|| |
|Stage II|| || |
|Stage III|| |
- Complete blood count:
- ↑ Inflammatory markers
- Check for signs of DIC → see
- Arterial blood gas analysis: Metabolic acidosis is associated with advanced NEC.
- Blood culture
- Abdominal radiography
- Abdominal ultrasound
|Differential diagnoses of necrotizing enterocolitis|
|Features||NEC||Spontaneous intestinal perforation|| |
|Infectious enteritis||Allergy to cow's milk|
| || || || |
|Other findings|| || || || |
The differential diagnoses listed here are not exhaustive.
- Stop enteral feeding → parenteral feeding and substitution of fluids
- Gut decompression via nasogastric tube
- IV broad-spectrum antibiotics: e.g., ampicillin, gentamicin, and metronidazole for anaerobic coverage
- Radiographic monitoring: plain supine abdominal radiographs every 6–12 hours in the initial phase of the disease
Surgery: primary peritoneal drainage and/or laparotomy with necrotic bowel excision
- Indications: perforation, peritonitis and/or clinical worsening despite medical therapy
- Intestinal perforation:
We list the most important complications. The selection is not exhaustive.
Mortality rate: approx. 10–30%
Breast milk has a protective effect