Necrotizing Enterocolitis

Treatment Overview

No matter what kind of treatment your newborn needs for necrotizing enterocolitis, it can be stressful to watch a fragile newborn undergo medical treatment. You may find that you feel overwhelmed by having a new baby with health problems. You may feel frustrated if you cannot hold your baby as often as you want or if you cannot breast-feed your baby, but instead have to pump your milk, which is then given to your baby through a tube. It can be helpful to talk about your feelings and concerns with a social worker or counselor. It is also a good idea to get to know the team of health professionals involved in your baby's care and to ask them questions about anything you do not understand.

Newborns with necrotizing enterocolitis may be treated by a variety of health professionals, including:

• Neonatologists.
• Gastroenterologists.
• Dietitians.
• Pediatric surgeons.

How much treatment your baby needs depends on how severely his or her intestines are damaged.

All newborns with necrotizing enterocolitis require:

• Temporary use of a nasogastric tube, which is inserted through the nose into the stomach to remove extra fluids and gas from the intestines.
• Daily measurement of your newborn's belly. If your baby's belly gets smaller, or he or she is able to pass stools, then the intestines are working normally again.

If your baby has mild necrotizing enterocolitis, treatment generally lasts 72 hours. If your baby has moderate necrotizing enterocolitis, treatment may continue for 7 to 10 days.

If your baby has severe necrotizing enterocolitis, treatment can last up to 21 days and may include:

• Oxygen therapy and possible treatment with a ventilator to make sure your baby is getting enough oxygen.
• A series of abdominal X-rays to see if the infection in the intestines is getting better or worse.
• Blood transfusions when there is a lot of bleeding or infection.
• Drugs such as dopamine that cause the heart to pump more blood, to increase blood pressure.

If your baby's intestines are healing, he or she may continue to get IV fluids while oral feedings are started. Most babies who have mild or moderate necrotizing enterocolitis will not have any ongoing problems with digestion, nutrition, and growth.

Surgery

If your baby has severe necrotizing enterocolitis and has a hole in the intestines, seriously damaged intestinal tissue, or bowel obstruction, he or she may need surgery. If surgery is required, it has two steps:

• In the first surgery, the upper part of the intestine is brought to the surface of the belly and a colostomy or ileostomy is created. The lower part of the intestine then does not have to digest food, which allows it to heal. In addition, severely damaged sections of the intestine are removed.
• The second surgery is performed weeks or months later, after the damaged intestine has healed. This surgery involves:
  • Closing the colostomy or ileostomy.
  • Surgically reconnecting a healthy upper section of the intestine to a healthy lower section (end-to-end anastomosis). This surgery allows body waste to pass normally through the intestines and leave the body through the newborn's rectum.

For several days after each surgery, your baby will be fed intravenously.

If your baby has only a small area of damaged tissue, some surgeons will do one surgery to remove the affected tissue and reconnect the intestines.

Complications

If your baby has surgery, he or she may develop a blockage of the intestine (stricture) up to 8 weeks after surgery. The symptoms of a blockage are the same as the symptoms of necrotizing enterocolitis. An X-ray can determine where the blockage is and what kind of treatment is needed.

Some newborns who have necrotizing enterocolitis later develop short bowel syndrome (short gut syndrome). Children with short bowel syndrome may not grow as tall, weigh as much, or develop as fast as other children their age because they cannot absorb enough calories from the food they eat. Infants with severe short bowel syndrome may need IV feeding for weeks or months. With training and support for caregivers, IV feeding may be done at home rather than at a hospital.

Many newborns who have necrotizing enterocolitis go on to live healthy lives, but about 1 out of 5 of these newborns do not survive.² Ongoing problems with digestion, growth, and development are most common both in infants who weighed less than 2.2 lb (1 kg) when they were born and in infants who had surgery to treat severe necrotizing enterocolitis.

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Author:	Debby Golonka, MPH	Last Updated: May 15, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Jennifer Merchant, MD - Neonatal-Perinatal Medicine
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