Some experts say that premature babies are susceptible to disease. One of them is that they are at risk of experiencing necrotizing enterocolitis ( NEC). However, it is possible that this can happen to full-term babies.
This disease often occurs in the first few weeks of life. Usually, the condition affects the baby’s intestinal tissue. If not treated properly, NEC can put a child at risk for long-term complications.
What exactly are the symptoms of necrotizing enterocolitis? Is there a way to prevent and treat the condition? Check out the following explanation!
Definition
Necrotizing enterocolitis (NEC) is the most common and serious intestinal disease among premature babies. It occurs when tissue in the small or large intestine becomes injured or inflamed. This can lead to the death of intestinal tissue.
In babies with NEC, the intestines can no longer accommodate waste. So bacteria can enter the bloodstream and cause life-threatening infections. Waste can enter the baby’s abdomen and make the baby very sick. The injured intestine, or part of it, may die and need to be removed.
NEC usually develops within two to six weeks of birth. In some babies, NEC is mild. If left untreated, it can lead to serious infections and death.
According to the Cleveland Clinic , necrotizing enterocolitis can be classified into several types based on when symptoms start and what causes the condition.
NEC Classic
This most common type of NEC tends to affect babies born before 28 weeks of pregnancy. Classic NEC occurs three to six weeks after birth. In most cases, the baby is stable and doing well. Then the condition comes on suddenly, without warning.
Transfusion-Related NEC
A baby may need a blood transfusion to treat anemia (lack of red blood cells). About 1 in 3 premature babies develop NEC within three days of receiving a blood transfusion.
Atypical NEC
Rarely, infants develop NEC in the first week of life or before the first feeding.
NEC Full Term Baby
Full-term babies who develop NEC usually have birth defects. Possible causes include congenital heart conditions, gastroschisis (intestines that form outside the body) and low oxygen levels at birth.
Although rare, outbreaks of NEC can occur in neonatal intensive care units (NICUs). NICUs provide advanced medical care for premature and critically ill infants. During an outbreak, several infants may develop NEC at the same time. Bacteria, such as e. coli, or other germs can cause these unusual outbreaks.
Symptom
Symptoms of NEC can vary from baby to baby, and like those caused by other digestive problems, they can appear over a few days or appear suddenly in a baby who seems fine.
Symptoms of necrotizing enterocolitis include:
- swollen, red, or tender abdomen
- difficulty eating
- food stays in the stomach longer than expected
- constipation
- diarrhea and/or dark or bloody stools (poop)
- become less active or lethargic
- low or unstable body temperature
- green vomit (contains bile)
- apnea (pause in breathing)
- bradycardia (slow heart rate)
- hypotension (low blood pressure).
Reason
According to WebMD , doctors aren’t sure if premature babies have weaker, less mature lungs and intestines than full-term babies. That means their bodies don’t move blood and oxygen around as well as they should. They also have trouble breaking down their food and fighting off infections.
In most cases, no specific cause is found. However, experts believe these things may play a role:
- underdeveloped intestine (premature).
- too little oxygen or blood flow to the intestines at birth or later
- injury to the lining of the intestine
- heavy growth of bacteria in the intestines that erodes the intestinal wall
- viral or bacterial infection of the intestines
- giving formula milk.
Necrotizing enterocolitis sometimes seems to occur in “clusters,” affecting several babies in the same nursery. This may be a coincidence, but some viruses and bacteria are sometimes found in babies with NEC. NEC is not spread from one baby to another, but the viruses or bacteria that cause it can. This is one reason why all nurseries and NICUs have very strict precautions to help prevent the spread of infection.
Risk Factors
This condition is more common in babies born prematurely (before 32 weeks). However, full-term babies who have health problems, such as heart defects, can also experience NEC.
Other factors include:
- The baby weighs less than 2.5 kg at birth.
- High-risk or premature infants who are fed formula by mouth or tube
- Those who have difficulty giving birth or experience decreased oxygen levels
- A baby who has too many red blood cells in circulation
- Infants with pre-existing gastrointestinal infections
- Seriously ill infants and those receiving blood transfusions.
Frequency of Occurrence
Necrotizing enterocolitis is rare. It affects only 1 in 10,000 full-term babies or 1 in 1,000 premature babies.
Diagnosis
The pediatrician will examine the baby and the swollen abdomen. In addition, some ways to detect necrotizing enterocolitis include:
- Blood tests : Blood tests check for bacteria and other signs of infection.
- Stool test : This test checks for blood in your baby’s stool. It can detect blood that isn’t visible.
- X-rays : An abdominal X-ray may show signs of NEC, including air (gas) bubbles around the intestines or in the abdominal cavity. Air bubbles may indicate damaged or perforated intestine.
Handling
Your baby’s intestines need time to rest and heal. The first step in treating necrotizing enterocolitis is to stop tube or oral feedings. Instead, your baby receives intravenous (IV) fluids and nutrition.
Your baby may also receive treatment using a nasogastric tube (a long, thin tube that goes through the nose or sometimes the mouth). The tube goes into the stomach to suck out gas and fluid. Antibiotics may also be given to help fight bacterial infections.
Your baby’s stools are also monitored for blood and the size of your baby’s abdomen is checked regularly. A hole in the intestine or an infection in the abdominal cavity will cause the abdomen to swell. If your baby’s abdomen is so swollen that it is affecting breathing, extra oxygen or a breathing machine (ventilator) will help the baby breathe. In addition, blood tests will look for bacteria and check for anemia (a decrease in red blood cells).
About 1 in 4 babies need surgery to remove dead bowel tissue and repair the hole. Your child’s provider can perform an ostomy procedure. This surgery:
- Making a small hole (stoma) in the child’s stomach.
- Connecting the colon to the stoma.
- Allows waste to leave the body through a stoma (an opening in the abdominal wall) into a pouch outside the body.
When the baby is stronger, the doctor will reattach the intestine and replace it in the abdomen.
However, if your child is too small (weighing less than 0.5 kg) or too sick for surgery, your doctor may place a drain (catheter) in the abdomen. Drainage aims to relieve symptoms by removing unhealthy or infected fluid and gas. If your baby still needs surgery later, it will be done when he or she is older and healthier.
After responding to treatment, the baby can return to regular breastfeeding after a week or two. Breast milk is recommended, not formula. Breast milk is beneficial for babies with NEC because it is easy to digest, supports the growth of healthy bacteria in the intestinal tract, and boosts the baby’s immunity. This is especially important for premature babies with immature immune systems.
For mothers who are unable to breastfeed or provide sufficient breast milk, doctors may recommend giving the baby pasteurized breast milk from a milk bank, which is considered a safe alternative. Special formulas may also be used.
Researchers are working on promising new treatments for necrotizing enterocolitis . Among them is the administration of probiotics , which are live bacteria and yeasts that are good for fighting off infection-causing bacteria and blocking nitric oxide (a gas produced by NEC). This helps break down the intestinal lining.
Possible Complications
Babies with necrotizing enterocolitis are at risk for other problems, such as:
Stomach Infection
Some babies develop a hole in the wall of their intestines. This perforation allows bacteria to enter the abdominal cavity. An infection called peritonitis can occur. Peritonitis increases the risk of a life-threatening blood infection called sepsis .
Intestinal Stricture
As many as 1 in 3 babies develop intestinal strictures. Strictures narrow the intestine. This condition usually occurs a few months after a baby recovers from NEC. The narrowed intestine makes it difficult for food to pass through. Some children need surgery to open the intestine.
Short Bowel Syndrome
If NEC destroys or damages part of the small intestine, a child may develop short bowel syndrome. This condition makes it difficult for the body to absorb fluids and nutrients (malabsorption). Children with short bowel syndrome need lifelong care to get the right nutrition to grow. Some children need to be fed through a tube (enteral).
Growth Failure and Developmental Delay
Important long-term complications include growth failure, poor neurodevelopmental outcomes, and developmental delay, especially in infants who require surgery. These infants require close follow-up to monitor growth and development.
Prevention
Currently, there is no way to prevent necrotizing enterocolitis . But studies show that babies who are exclusively breastfed (without formula) are less likely to develop the disease. That’s why doctors recommend breastfeeding babies at risk, starting with small amounts.
Regardless, if you are at risk of premature birth, you may be given a corticosteroid injection. This medication improves the health of your unborn baby. It can reduce the chances of your baby having lung and bowel problems.
Pregnant women must also maintain their health during pregnancy to avoid infections in the mother and fetus by consuming nutritious foods, supplements, and carrying out regular pregnancy check-ups.
That is some related informationnecrotizing enterocolitis. Hope it is useful for you!
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Republished with permission from theAsianParent Indonesia
