Moderate NEC
In many cases where NEC is strongly suspected, the clinical team looking after the baby will medically, or conservatively, manage the condition. Although the baby’s state and test results are important, it is not possible to be absolutely certain it is NEC or what will happen next.
Oral feeds and medications are stopped for 5-14 days and the baby is given nutrients and antibiotics directly into a vein (intravenously, “a drip”). A nasogastric tube, which is passed into the baby’s nose to reach the stomach, helps to drain the contents of the stomach and intestines. These measures are to allow the intestines time to rest and heal.
The baby will be closely monitored and supported. They will be helped to breathe if necessary, and blood tests and X-rays will be repeated as appropriate. When a baby is well enough for milk feeds, it is best only to use mother’s breast milk or donor breast milk as this is better tolerated than formula milk, which is based on cow’s milk. In some situations, a specialised ‘simpler’ milk may be tried if breast milk is not tolerated.
Continuing with these medical treatments often results in a complete recovery with no long-term effects on the baby’s development.
Alternatively, if the condition progresses, there may be episodes of vomiting of blood or bile which may be seen in the fluids drained away in the nasogastric tube. The baby may develop a painful swollen abdomen with changes in the colour and appearance of the skin; they may have fresh blood in their stools; there may also be changes in body temperature, low blood pressure and significant changes in the baby’s heart and breathing rates. They will usually be supported to breathe.
As all interventions can be distressing, the baby may be put on a morphine drip and they will be closely observed. Repeated blood tests and X-rays will be required to assess progress and to help make the diagnosis.
However, if a baby does not get better with medical treatment a decision may be made to operate. If there is a perforation (hole) in the bowel wall and an area of tissue dies, urgent surgical treatment will become necessary.
Disclaimer: This information has been produced using contributions to meetings of the Special Interest Group in Necrotizing Enterocolitis (SIGNEC). It is intended to help parents and their families to understand this serious condition and ways in which it is treated. It is not a substitute for discussion with those responsible for the care of a baby as every baby is unique. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented and the diagnostic or treatment options available. While all reasonable efforts have been made to check the contents of external sites, links are not an endorsement of those sites.
