What Is Necrotizing Enterocolitis?
It is a disease of the intestines in which infection and later swelling of the inner lining of the intestines occur. This leads to the formation of a hole and then leakage of the intestinal content into the abdomen and the rest of the body with the death of the intestinal tissue.
After the death of parts of the intestines, and leakage into the abdomen and the rest of the body, the baby is at the risk of developing other infections because of the spread of the bacteria to the blood. This infection can affect any organ of the body, weakening the baby.
It is a common disease in newborns, occurring within the first four weeks after birth. It affects 7% of all prematurely born babies. It is a life-threatening condition among newborns, and out of the 7% affected, 50% are likely to die even with treatment.
The Effect On Newborns
Necrotizing Enterocolitis is a disease of newborns, most likely to occur in the second or third week after birth. It is most common in babies who are either born early, premature or are very small even at term, with a weight of less than 1.5Kg. It can also affect babies born at term and of a healthy weight, but with other diseases like a heart problem.
The exact cause of Necrotizing Enterocolitis is not known, but some risk factors might contribute to it. This includes underdeveloped intestines, due to premature birth. Due to a difficult and long labour, blood supply to some part of the body can reduce, causing the death of that area in the baby.
Other causes include the use of artificial milk for feeding the baby, immediately after birth. Sometimes babies can get an infection from another baby, in the nursery of the hospital, if care is not taken to prevent it. Some cases have also been reported after blood transfusions.
Signs & Symptoms
The most common symptoms are diarrhoea and vomiting. The other symptoms include painful belly, redness, and swelling of abdomen and blood in faeces. The baby might also look pale with slow, difficult breathing.
The baby will refuse to feed or feed very little. It might cry continuously due to pain or lie weakly at one place without any activity.
These include a hole in the intestines, which is an emergency. If the hole is not surgically repaired, then it can prove to be fatal for the baby. After removing the hole and scar tissue by surgery, only a small part of the intestines will be left to absorb the food.
An additional complication is the formation of scars and narrowing of the intestinal wall, which might lead to feeding and absorbing difficulties. If the intestines don’t absorb food either due to the small size or because of the scars, then the baby won’t gain weight.
Due to a lack of absorption, the baby will always be hungry and require a number of feeds, but in tiny amounts, so that it can easily absorb the food. Another problem because of necrotizing enterocolitis is an increase in the chances of getting other infections.
To prevent necrotizing enterocolitis, the Indian Academy of Pediatrics recommends the use of breast milk for feeding premature babies. This can reduce the risk of developing infection by two to three times, even if that milk is given through machines.
If milk is not available from the mother, then milk from a donor can be used. Other than the breast milk, fat-containing supplements can also decrease the risk of this infection. These supplements contain fats, vitamins, and probiotics that protect the baby from infections.
It has also been seen that babies with a birth weight of less than 1kg, who have been fed breast milk developed necrotizing enterocolitis at a rate of 1.3%, while in those who were given artificial formulas, 11.1% develop necrotizing enterocolitis.
Diagnosis is based on the clinical symptoms of the disease. There are three stages of the disease, stage 1 (Mild), stage 2 (Moderate) and stage 3 (Severe). If the baby only has a weakness, increased abdomen size and small blood spots on the diaper, then it is a mild form of the disease.
In stage 2 or moderate form, there will be pain in the abdomen, along with, a number of irregular blood tests such as low blood counts. There will be no bowel sound present in the abdomen. An X-ray will also show air in the abdomen.
In Stage 3, the baby will have very low blood pressure. It will be accompanied by an increase in the size of the abdomen along with an infection in the whole abdomen. Air in the abdomen will be seen in the X-ray, which is due to a hole in the intestines.
Treatment & Care
The treatment includes completely stopping feeding by mouth. All the foods already present in the abdomen will be removed, and antibiotics will be started. Fluids and feedings will be given through veins.
If there is a hole in the intestines, then it will have to be treated by surgery. The indications for surgery include no response to medication, the presence of air in the abdomen, change of colour of the abdomen to red and later to blue-black.
Necrotizing enterocolitis is a severe and life-threatening condition that should be treated in a hospital. If there is a suspicion that a premature, low-weight newborn is suffering from it, immediately take it to a hospital.
The most critical factor in the prevention of this infection is the use of breast milk to feed the baby, either by mouth at home or by tubes in the hospital.