Necrotizing enterocolitis (NEC) is a gastrointestinal condition that affects newborns. Intestinal cells can get infected and inflamed, causing damage or cell death. The issue can then allow intestinal bacteria to travel out into the abdomen and cause further damage. In the most severe cases, holes in the bowels can leak stool into the abdomen, causing serious injury and even death.
The condition mostly affects premature newborns. According to the Children’s Hospital of Pittsburgh (CHP), NEC only affects one in 2,000 births, but it is the most common gastrointestinal condition found in neonatal care units. Many cases occur when premature patients are not feeding properly. The CHP reports that 80 percent of the cases involve babies with a birth weight below 4.5 pounds. Additionally, 10 percent of babies born below that weight developed NEC.
What are Symptoms of NEC?
NEC can worsen quickly so early identification is key to treatment. There are three stages of progression, often called Bell stages, with differing symptoms.
Stage 1 features:
- Bloody stools
- Mild abdominal bloating
- An unstable temperature
- Lethargy or diminished activity
- Slowed heart rate
- Vomiting
Stage 2 has all the symptoms of Stage 1, along with:
- Pain when the abdomen is touched
- Reduced or no intestinal movement
- Slightly reduced blood platelet levels
- Excess of lactic acid
- Growth of gas-filled spaces in the intestine
- No bowel sounds
Stage 3, which is advanced NEC, includes all the symptoms of Stages 1 and 2, as well as:
- Redness in the abdomen
- Buildup of fluid and gas in the abdomen cavity
- Inflammation in the abdomen
- Stop of urination
- Low blood pressure
- Periods of not breathing
- Excess acid
- Decreased number of certain white blood cells
- Blood clot formation
The longer the disease progresses without treatment, the worse it gets. Timing is very important to address symptoms and prevent the spread of the disease.
What can Contribute to NEC?
Certain factors can contribute to NEC once a premature baby is undergoing treatment. Multiple scientific studies have pointed to the feeding of certain baby formulas to help underweight babies grow as a possible causation to NEC. Some hospitals used milk-based formulas to spur weight gain, sometimes foregoing regular breastmilk feedings with the mother, but this can hasten the spread of NEC. Clinicians point to the make-up of these formulas, the rate of feedings, and the underdeveloped mucous membranes of premature intestines as risk factors.
The inability to process the proteins, lipids, and other nutrients in the formula can cause or worsen NEC in some patients. While patients receiving breastmilk can still get NEC, infection rates are significantly lower. Other factors can lead to NEC while in a hospital. Blood transfusions can cause the infection. Also, NEC can spread in neonatal units if one baby is affected. Most facilities will try to isolate cases when a patient is diagnosed initially.
How Do Physicians Treat NEC?
There are a variety of options for doctors to treat NEC patients, and much of it has to do with the progress of the disease, when the diagnosis occurred, and what has been done already. Diagnosis can involve physical tests, like an X-ray of the abdomen or lab tests to analyze blood, stool, or urine. The tests can determine if NEC is present and at what stage.
If it is detected early, NEC can be treated internally and without much affect on the patient. Most cases will involve the cessation of normal feedings, breastmilk and/or formula, and the usage of an intravenous tube. A key factor in determining treatment options is the size of the affected area and the condition of the intestine. If the intestine wall has not been perforated and if the infection has only damaged a small section of the organ, physicians will likely monitor the situation and continue tests.
More complex solutions come into play if the disease is detected later or has progressed. Doctors can administer antibiotics to address the infection. A tube may be inserted into the stomach to relieve the buildup of gas. If regular breathing is not occurring, the patient may be put on a breathing machine or receive oxygen. If issues occur with blood platelets or red blood cells, a transfusion may occur.
Most NEC patients will not need surgery. Usually, this is a last resort when other treatments have not worked. In cases where the intestine wall has torn and the disease has reached Stage 3 with further damage to the abdomen, surgery becomes a viable option. Doctors will work to close the hole in the intestine wall or bowel and clean up any debris that could cause other medical issues. It is possible a damaged piece of intestine may be removed, or a stoma may be implanted if bowel function has been compromised.
How Long Does it Take NEC Patients to Recover?
While the disease can be devastating, it can also be resolved fairly quickly. Most patients respond to treatment within 72 hours. Once the signs of infection go away, patients can go back to mouth feeding in five to seven days. However, it may take two weeks or longer to return infants to regular feedings. If doctors have to use a stoma for a patient with bowel issues, the timeline may go beyond six to eight weeks.
After the treatment, most patients can grow and develop normally. Sometimes, there are issues with tissue scarring in the intestine, which can lead to blockages and require future surgery. Patients who require surgery that removes a significant portion of intestine may deal with malabsorption throughout life. The direst cases may require a bowel transplant to survive if so much intestine has been removed. In the worst scenarios, NEC can be fatal.
A NEC diagnosis can send families into confusion and worry. There are so many questions to ask and decisions to make under great duress. While doctors and hospitals will try to do everything they can for a child, it is possible something went wrong on their end.
St. Louis NEC Lawyers at The Cates Law Firm, LLC Help NEC Patients with Medical Malpractice Cases
There are many treatment options for NEC, but it is also important to know what caused it in the first place. If you suspect medical malpractice caused your baby’s NEC diagnosis, the St. Louis NEC lawyers at The Cates Law Firm, LLC can help. Call us at 618-277-3644 or contact us online for a free consultation. Based in Swansea, Illinois, we are ready to serve families 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.