Necrotizing enterocolitis

The exact cause is unclear. Maternal factors such as chorioamnionitis, cocaine abuse, intrauterine growth restriction, intrahepatic cholestasis during pregnancy, increased body mass index, lack of prenatal steroids, mode of delivery, placental abruption, pre eclampsia, and smoking have not been consistently implicated with the development of NEC. Other risk factors potentially implicated include congenital heart disease, birth asphyxia, exchange transfusion, and prelabor rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. The condition was first described between 1888 and 1891. Initial symptoms include feeding intolerance and failure to thrive, increased gastric residuals, abdominal distension, and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.

The exact cause is unclear.

Prevention includes the use of breast milk and probiotics. Small amounts of oral feeds of human milk starting as soon as possible, while the infant is being primarily fed intravenously, primes the immature gut to mature and become ready to receive greater intake by mouth. Human milk from a milk bank or donor can be used if mother's milk is unavailable. The gut mucosal cells do not get enough nourishment from arterial blood supply to stay healthy, especially in very premature infants, where the blood supply is limited due to immature development of the capillaries, so nutrients from the lumen of the gut are needed. Towards understanding intervention with human milk, experts have noted cow's and human milk differ in their immunoglobular and glycan compositions. Due to their relative ease of production, human milk oligosaccharides (HMO) are a subject of particular interest in supplementation and intervention. A Cochrane review in 2020 (updated in 2023) found low to moderate quality evidence that supplementation of probiotics enterally "prevents severe NEC, as well as all cause mortality in preterm infants" but cautioned that the evidence was not sufficient to inform policy and practice and that further high quality trials are needed. Advancing enteral feed volumes at lower rates does not appear to reduce the risk of NEC or death in very preterm infants and seems to increase the risk of invasive infection. Not beginning feeding an infant by mouth for more than 4 days does not appear to have protective benefits.

If a baby is diagnosed with NEC, treatment should begin immediately. and prompt antibiotic therapy. Monitoring is clinical, although serial supine and left lateral decubitus abdominal X rays should be performed every six hours. As an infant recovers from NEC, feeds are gradually introduced. "Trophic feeds" or low volume feeds (<20 ml/kg/day) are usually initiated first. How and what to feed are determined by the extent of bowel involved, the need for surgical intervention, and the infant's clinical appearance. Where the disease is not halted through medical treatment alone, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is generally required, although abdominal drains may be placed in very unstable infants as a temporizing measure. Surgery may require a colostomy, which may be able to be reversed at a later time. Some children may develop short bowel syndrome if extensive portions of the bowel must be removed. In the case of an infant whose bowel is left in discontinuity, the surgical creation of a mucous fistula or connection to the distal bowel may be helpful, as this allows for refeeding of ostomy output to the distal bowel. This refeeding process is believed to improve bowel adaptation and aid in advancement of feeds. When NEC is diagnosed and treated immediately, the prognosis for babies is generally very good. Most babies recover fully without any additional health problems. Medical management of NEC shows an increased chance of survival compared to surgical management. Despite a significant mortality risk, long term prognosis for infants undergoing NEC surgery is improving, with survival rates of 70–80%. However, "Surgical NEC" survivors are still at risk for possible long term complications, such as narrowing of the intestines or short bowel syndrome and neurodevelopmental disability.

The NEC Society is a 501(c)(3), non profit organization dedicated to building a world without necrotizing enterocolitis (NEC) through research, advocacy, and education. The NEC Society was launched in January 2014 by Jennifer Canvasser after her son, Micah, died from complications of NEC just before his first birthday. The NEC Society is a patient led organization that collaborates with expert clinicians and researchers to better understand, prevent, and treat this devastating neonatal intestinal disease. Today, patient families and experts from around the world work together to improve outcomes for the most vulnerable infants at risk of NEC. Their work and numerous initiatives combine the patient family perspective with solutions based on the best available scientific evidence.

The NEC Society hosts an in person, biennial Symposium where clinicians, scientists and patient families come together to listen, learn and collaborate. It is held as an “All In Meeting", where all stakeholders are fully integrated and empowered. Patient families are central to the planning, preparation, and execution of the meeting. Each session is dedicated to a baby affected by NEC. Patient families take part in each session as faculty and also present posters.