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What is Necrotizing Enterocolitis (NEC)?

Necrotizing Enterocolitis (neck-ro-tie-zing-en-tear-oh-ko-lie- tis), or NEC, describes an infection that inflames part of a baby’s intestines. This disease, which can often require surgery to remove damaged sections of intestine, often develops two to three weeks after birth, but can occur much later. “Necrotizing” means damage and/or death of cells, “entero” refers to the intestine, and “colitis” means inflammation of the colon (lower part of the intestine). It can lead to intolerance to feedings, abdominal swelling and other serious complications. This occurs predominantly in premature infants. Babies who have NEC are treated with antibiotics and fed intravenously (through a vein) while the intestine heals.

A visual sign of NEC is a swollen, red, or tender belly

Photo Source: Cincinnati Children

What causes NEC?

The cause of NEC is unknown. NEC is most common in extremely premature babies and/or babies who are already ill. Other possible risk factors may include:

  • Low birth weight (babies who weigh less than 2500 grams or 5 pounds 8 ounces)
  • Chorioamnionitis (infection in the placenta and the fluid surrounding the baby which most often happens when the mother’s water breaks and when the baby is delivered)
  • Low oxygen levels during birth
  • Congenital heart disease. “Congenital” means existing at birth
  • Blood transfusion

What are some symptoms of NEC?

Onset of symptoms can occur slowly or quickly. Some of them include:

  • Vomiting
  • Diarrhea
  • Bloating of stomach
  • Low activity level
  • Blood in stool
  • Poor feeding tolerance
  • Abnormal body temperature (either too low or too high)

Can you prevent NEC from occurring?

According to the March of Dimes, when a health care provider suspects that a woman may deliver before 34 weeks of pregnancy, he/she may suggest treating her with a one of several drugs called tocolytics, which often delays preterm labor for about 48 hours. This buys them time to treat the pregnant woman with a medicine called corticosteroids. Corticosteroids speeds maturation of the fetal lungs and significantly reduces the risk of serious complications such as Respiratory Distress Syndrome or RDS (breathing problems), Intraventricular Hemorrhage or IVH (bleeding in the brain) and infant death.1 For those babies who are still born early, despite the use of the meds listed above, there is still hope. A clinical study published in 2010 found that premature babies who were born weighing between 500 and 1250 grams and fed Prolact+ H2MF® added to human milk had 77% lower odds of developing NEC when compared to infants receiving human milk fortified with cow’s milk-based HMF or, when supply of mother’s own milk was insufficient, preterm infant formula.2

Is NEC life-threatening?

Yes. NEC is a dangerous and severe complication that often affects extremely preterm infants, in which the intestinal tissue disintegrates. NEC requires surgical intervention to remove the dead portions of the intestines or to insert a drain in 20% – 40% of the cases. The fatality rate of NEC surgery can be high as 50%.3 Early, aggressive treatment helps improve the chances of survival.

Treating NEC

When a baby is diagnosed with NEC:

  • They are no longer fed through their mouths
  • A tube is inserted into the baby’s stomach to relieve gas pressure
  • They are given antibiotics
  • Fluids are given through an IV

How do you know if a baby with NEC is making progress?

The NICU team will keep parents up-to-date on their baby’s progress. At first, babies with NEC receive X-rays and blood tests several times a day. As the baby gets better, these tests may get less frequent.

When would surgery be required to treat NEC?

  • If there is a lot of damage to the intestine
  • If there are perforations (holes or tears) in the wall of the intestine
  • If the baby has inflammation of the inner wall of the abdomen (peritonitis)
  • If the baby is not getting better with non-surgical treatment

The fatality rate of NEC surgery is as high as 50%.3

The number of cases of NEC requiring surgery was significantly lower in infants* fed an exclusively human milk-based diet, which included Prolact+ H2MF®.2

* Those born weighing between 500 and 1250 grams.

  1. March of Dimes (2013). What we know about prematurity. Retrieved April 5, 2013 from
  2. Sullivan S, Schanler RJ, Kim JH et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk based products. J Pediatr. 2009: 156(4):562-567.
  3. Schnabl KL, et al. Nectrotizing Enterocolitis: A multifactorial disease with no cure. World J Gastroenterol. 2008; 14(14): 2142-2161.

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