Necrotizing Enterocolitis

Necrotizing enterocolitis is a disease in which intestinal tissue dies. It primarily affects premature or sick newborns. Research indicates it may be caused by a virus, because risk factors include outbreaks in other infants in the nursery and premature infants whose immune systems are weak. Also at risk are infants who receive concentrated formula and those who have received blood transfusions.

In this disease, the lining of the intestinal wall dies and falls off.

Symptoms include swollen abdomen, irritability, vomiting and inability to tolerate feedings, blood in the stool, weakness, fatigue, diarrhea and sometimes temperature swings.

To diagnose the disease, the physician orders an abdominal X-ray, which is painless, and tests the stool for blood (also painless). He or she will stick the baby with a needle to draw blood so the baby’s red blood cell count, white blood cell count and platelet count can be determined.

In a baby in whom this is suspected, the physician will stop all foods by mouth and start an IV to give the baby fluid. A small tube is inserted through the nose into the stomach to remove gas and pain. Antibiotics are ordered to fight the infection causing the enterocolitis.

If the bacteria fight through the intestinal wall and cause a hole (perforation), or infection of the abdominal lining (peritonitis) develops from the dead intestinal tissue, surgery is necessary. An incision is made in the abdomen with the baby under general anesthesia, and the dead tissue is removed. The surgeon creates a colostomy in which the healthy bowel is brought up to the skin, and the edges are stitched to the outside. A drainage bag is attached, and the abdominal incision is closed. The bowel is then reconnected weeks or months later when the patient is healthy.

This is a serious disease with a death rate about 25 percent. The earlier and more aggressive the treatment, the better the success rate.

There are some potential complications. In addition to the normal risk of breathing problems and infection related to surgery, sepsis (infection of the blood), peritonitis (infection of the lining of the abdomen) and intestinal stricture (a narrowing of the intestine that can lead to bowel obstruction) all can occur.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.