What are the Risk Factors of Necrotizing Enterocolitis?

Necrotizing Enterocolitis X-Ray

Necrotizing enterocolitis (NEC) is a serious infection of the intestines. It is most commonly found in the large intestine of newborn babies and is very dangerous.  With NEC, tissue becomes inflamed and damages part of the intestines. NEC can cause an opening in the intestines and bacteria can enter the abdominal cavity and cause an infection to spread.

Symptoms usually begin within the first few weeks of birth and often include one or more of the following signs:

  • Feeding intolerance
  • Lethargy
  • Abdominal distention
  • Failure to move food through the intestines
  • Green fluid in the stomach
  • Bloody bowel movements
  • Temperature instability

Some of these symptoms are similar to those caused by other conditions, making NEC difficult to diagnose. NEC can spread fast and it can be difficult to treat. While all babies can get NEC, the condition is rare in full-term newborns.

What Medical Care Do Premature Babies Require?

The incidence of premature birth is increasing in the United States and worldwide. Premature babies are underdeveloped and often require a variety of medical interventions to survive. They often have difficulty maintaining their body temperature, inhaling enough air, ingesting food, and digesting food. 

Typical management includes placing the baby in an incubator that maintains a steady and warm body temperature, providing fluids and nutrients through a feeding tube, and providing continuous positive airway pressure through a mask or nasal cannula. Vital signs of infants, including temperature and blood pressure, are monitored frequently to ensure they are doing well and to detect any problems.

Is My Baby at Risk of Getting NEC?

Studies have been performed to understand the likely risk factors of NEC. Understanding risk factors can aid practitioners in early identification of NEC. This understanding can enable medical professionals to treat NEC as early as possible and improve outcomes. Certain techniques are suggested for babies at risk of NEC. These include preventive strategies, such as administration of prenatal glucocorticoid, use of breast milk for nutrition, and providing probiotic supplements. The vast majority of NEC cases in developed countries occur in extremely preterm infants of less than 32 weeks or in infants with low birth weight.

Infants requiring mechanical respiration for breathing support are more likely to develop NEC than those who do not require it. One study released by Karger Publishers states that time on a ventilator increases the chance of developing NEC. In addition, the study also found that infants that experienced nosocomial infections appeared to be at elevated risk of developing NEC. The study found that as the number of nosocomial infections experienced by an infant increased, so did the chance of developing NEC. While these conditions do not cause NEC, an infant having one or more of these conditions is at a higher risk of developing NEC.

There are other risk factors that appear to be linked to NEC. Babies born after a difficult labor are often born with low oxygen levels and a higher percentage of these babies develop NEC.

Other studies have found that feeding babies with infant formula can also develop NEC. The content of formula has been linked to higher incidences of NEC. In one study published on the National Library of Medicine site, administration of formula made with maltodextrin was compared to formula with lactose with administration of colostrum as a control. The study found that the use of maltodextrin caused a 50 percent incidence of NEC with 30 percent mortality. Administration of the lactose and the control resulted in zero cases of NEC. 

The incidence of NEC among preterm babies appears to be lower in babies fed breast milk compared to those given formula. Breast milk is believed to be protective and to reduce the risk of babies developing NEC. 

Other risk factors are not as clearly linked to NEC. However, having abnormal results in these metrics were found to be indicators of an increased risk of mortality from NEC:

  • Five-minute Apgar score
  • Leukopenia
  • Thrombocytopenia
  • Highest C-reaction protein

How can NEC be Detected?

Preterm babies must be monitored carefully. Early detection and treatment of NEC can lead to better outcomes. A doctor may notice tenderness and swelling of the abdomen during a physical exam. Palpation of the abdomen may also result in detecting reveal a mass where a perforation exists. NEC may also be suspected if there is redness in the abdominal area. 

If NEC is suspected, a follow up abdominal X-ray will enable confirmation of the diagnosis. Finding multiple small bubbles in the wall of the intestine on X-ray exams, called pneumatosis intestinalis, verifies NEC is present. 

Progression of the disease and/or success of treatment can be tracked by performing subsequent X-rays after treatment is initiated. If the X-ray shows air in the large veins of the liver, then it means that bacteria from the infection has spread. This happens in more severe cases of the condition. 

What Happens if an Infant Gets NEC?

NEC can be serious and requires immediate treatment. One or more possible responses to the detection of NEC include: 

  • Providing nutrients through an intravenous catheter.
  • Removing gas from the stomach and intestine using a nasogastric tube.
  • Antibiotic therapy.

Progress is tracked to determine if more aggressive treatment is required, including blood tests and examining the stool for blood. 

More severe cases may require more aggressive treatment. Transfusions of platelets or red blood cells may be required. While most cases of NEC do not require surgery, it is sometimes necessary to perform surgery to remove necrotic tissue. Sometimes, surgery is followed by placing a drain in the abdomen to remove fluids. A temporary ostomy or opening of the wall of the intestine is created to remove waste and allow the bowel to heal. Sometimes, follow-up surgeries are needed if the first surgery does not resolve the issue.

Are There Lasting Complications from NEC?

Many infants diagnosed and treated with NEC can recover and are able to lead normal lives. Complications from NEC are possible, including a hole in the intestines and widespread infection. Some infants treated for NEC experience scarring or narrowed areas in the intestines and difficulty absorbing nutrients. Long-term impacts are also possible, including poor growth and neurodevelopmental impairment.

Giving birth to a premature baby comes with many challenges. It is vitally important to ensure premature babies and other babies with risk factors for NEC get proper treatment and care. A late diagnosis or improper treatment can be catastrophic to a baby or even fatal. If parents suspect medical malpractice caused their baby’s NEC diagnosis, they should speak to a lawyer right away.

St. Louis NEC Lawyers at The Cates Law Firm, LLC Fight for Those Affected by NEC

The experienced St. Louis NEC lawyers at The Cates Law Firm, LLC can help evaluate your NEC case and determine if it is possible to seek compensation for medical errors and malpractice. We understand that NEC is devastating, especially when medical mistakes caused the diagnosis. Located in Swansea, Illinois, we serve clients throughout St. Louis, Belleville, East St. Louis, Edwardsville, Granite City, Waterloo, Chester, Carbondale, St. Clair County, Madison County, Monroe County, Randolph County, and other regions throughout southern Illinois. Complete our online form or call us at 618-277-3644 for a free consultation.