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Necrotizing Enterocolitis (NEC)

Necrotizing enterocolitis is a disease that primarily affects the intestine of premature infants and is the leading cause of pediatric short bowel syndrome. The wall of the intestine is invaded by bacteria, which causes local infection and inflammation that can ultimately destroy the wall of the intestine. The destruction of the bowel wall can lead to perforation (hole formation) of the intestine and spillage of the intestinal contents into the infant’s abdomen, resulting in overwhelming infection and possible death. (1)

Signs and Symptoms:

  • Inability to tolerate feeds

  • Abdominal distention

  • Vomiting bile (green)

Diagnosis is usually based on abdominal x-ray and a variety of laboratory studies.

Treatment: Medical treatment is the first step including insertion of a nasogastric tube (NG) to help decompress the stomach, administration of intravenous (IV) fluids and antibiotics, and stopping oral feedings. Surgical treatment may be indicated if the child has clinical deterioration despite optimal medical management, develops an intestinal stricture, or there is presence of a pneumoperitoneum (air in the peritoneal cavity) which usually indicates intestinal perforation.


  1.  Necrotizing Enterocolitis. CHLA. Published October 16, 2018. Accessed April 29, 2020.

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