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by Lucey JR

Necrotizing Enterocolitis



Necrotizing enterocolitis (NEC) is a serious condition of the intestine. The intestine digests food as it propels it through the digestive tract. NEC involves intestinal inflammation and tissue death. This condition often occurs soon after your baby starts feeding.
NEC can be a serious condition and requires immediate care. It often occurs in the first 2 weeks of life, but can occur as late as 3 months of age. The baby is often still in the hospital when NEC starts.
Necrotizing Enterocolitis
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The exact cause of NEC is not known. Below is a possible series of events that can lead to NEC:
  • Premature babies do not have fully developed intestines. This may make it difficult for the intestines to handle the stress of moving food.
  • The stress may cause a decrease in oxygen or blood flow to the intestines. The loss of oxygen and blood flow can cause damage to the intestine.
  • Bacteria can enter the intestine through the damaged area. The bacteria can lead to an infection and swelling. This will weaken the wall of the intestine even further.
  • If the process continues it can perforate the intestine.

Risk Factors

NEC is mostly found in premature and very low birthweight babies, but it can occur in full-term infants. Factors that may increase your baby's chance of NEC include:
  • A difficult delivery or low oxygen levels during labor
  • A gastrointestinal infection
  • Indomethacin or early dexamethasone treatment
  • Being considered as high risk and having started taking milk by mouth or feeding tube


NEC may cause:
  • Difficulty feeding
  • Feedings remaining in your baby’s stomach longer than expected
  • A sudden increase in bowel movements or lack of bowel movements
  • Bloody bowel movements
  • Baby doesn’t pass a lot of gas
  • Bloated abdomen that may be tender to the touch or red
  • Vomiting, which may be greenish in color
General signs of infection include:
  • Stopping breathing or difficulty breathing
  • Low heart rate
  • Sluggishness
  • Vomiting
  • Temperature instability
  • Cool, clammy skin


You will be asked about your baby’s symptoms and medical history. A physical exam will be done. Your baby's doctor will work with a specialist to diagnose NEC.
Your baby's bodily fluids will be tested. This can be done with:
  • Blood tests
  • Blood culture
Images may be taken of your baby's bodily structures. This can be done with:


Most babies who get NEC have a complete recovery. Treatment usually takes between 3 to 14 days. Treatment options include combinations of the following:

Empty the Stomach

Air or liquid in a baby’s intestine can make the condition worse. The baby will need to stop feeding. A tube will be placed through the baby's nose into the stomach. This tube will remove liquid and air from the baby’s stomach. This helps the intestine heal.
Nutrition and fluids will be given to your the through an IV. An IV can deliver nutrition directly into the child's blood stream.


Antibiotics are used to fight infections caused by bacteria. The baby may be given antibiotics if an infection is present or possible.


X-rays will be done often. They will help the doctor see the progress of the NEC.


NEC can cause swelling in the stomach. This may make it difficult for the baby to breathe. Oxygen may be given to improve the baby's oxygen levels. A ventilator may be used to help or take over breathing for the baby.

Infection Prevention

Some infections can pass easily through touch or near contact. Certain steps can keep these infections from spreading. Caretakers may wear gowns and gloves to protect the baby and others. Regular handwashing is also important for infection prevention.


For some, the damage to the intestine may be severe. In this case, surgery may be needed.
Surgery is done to remove the damaged part of the intestine. The healthy parts are sewn back together when possible. Sometimes there is too much damage to be able to sew the intestine back together. In this case, part of the intestine will be connected to an opening in the abdomen wall. The opening will allow waste products to pass to a bag outside the body.


Prevention is difficult since the exact cause of NEC is unknown. Some steps that may be helpful include:
  • Breastmilk may reduce the chance of getting NEC compared to formula.
  • Closely observe your baby for signs of feeding intolerance.
  • Probiotics may help decrease the risk of NEC in some cases.


Healthy Children—American Academy of Pediatrics
National Institute of Child Health and Human Development


Health Canada
Public Health Agency of Canada


Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for necrotizing enterocolitis (NEC) among very low birth weight infants. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2010 Oct 7. Accessed July 25, 2012.
Necrotizing enterocolitis. EBSCO DynaMed Plus website. Available at: . Updated September 4, 2017. Accessed September 21, 2017.
Pietz J, Achanti B, et al. Prevention of necrotizing enterocolitis in preterm infants: A 20-year experience. Pediatrics. 2007; 119:164-170.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 09/2018
  • Update Date: 09/30/2013
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