Most common gastrointestinal medical and/or surgical emergency occurring in

neonates

Etiology
o Remains unknown
o Ischemia and/or reperfusion injury may play a role
o Cluster cases and outbreaks in nurseries imply an infectious etiology

A single causative organism has not been found

o Translocation of intestinal flora across compromised mucosa may play a role

Incidence and age at onset

o More common in premature infants

But can also be seen in term babies

o Inversely related to birth weight and gestational age

o Term infants develop NEC earlier after birth than preemies

Average age of onset occurs within first week of life

Affected term neonates are usually systemically ill with other

conditions such as birth asphyxia, respiratory distress or congenital
heart disease

o Premature babies are at risk for several weeks after birth

o Babies who are breastfed have a lower incidence of NEC than formula-fed
babies

Clinical findings
o Initial symptoms may be subtle and can include the following

Feeding intolerance

Delayed gastric emptying

Abdominal distention and/or tenderness

Ileus/decreased bowel sounds

Imaging findings
o Acute disease most commonly affects the terminal ileum
o Plain film of the abdomen remains method in which disease is diagnosed most
often
o Findings include

Dilated loops of bowel

Thickened bowel walls

Fixed and dilated loop that persists is especially worrisome

Absence of bowel gas

Pneumatosis intestinalis

Pathognomonic of NEC in newborn

o Linear radiolucency parallels bowel lumen within bowel
wall
o Represents air that has entered from the lumen

Red arrows point to linear bands of radiolucency which parallel the wall of the
bowel indicating the presence of pneumatosis intestinalis in necrotizing
enterocolitis
For a the same photo without the arrows, click here

Abdominal free air

Ominous
o Usually requires emergency surgical intervention

May require a left lateral decubitus view to be seen

Portal venous gas

Originally thought to be ominous but is now considered less so

Appears as linear branching areas of decreased density over periphery of the

liver
o Represents air in portal venous system

Ascites

Late finding

Develops after perforation when peritonitis is present

Complications
o Occur in about 75% of all patients survive

Of those who survive, 50% develop a long-term complication

o Two most common complications are intestinal stricture and short-gut

syndrome
o Intestinal strictures

Can develop in infants with or without a preceding perforation

Incidence is 25-33%

Strictures most commonly involve the left side of the colon

Diagnosed with barium enema

o Short-gut syndrome

Malabsorption syndrome resulting from removal of excessive or

critical portions of small

Neonatal gut will grow this growth may take as long as 2 years to
occur

Mortality
o Mortality rate ranges from 10-44% in infants weighing less than 1500 g