Necrotizing Enterocolitis (NEC): A Too Common Condition of Premature Babies

As horrible as it sounds, necrotizing enterocolitis, often just called NEC, is where part of the intestinal is injured or dies.  It seems to develop when feedings are introduced into a vulnerable intestine with an area of diminished blood supply.  That vulnerability seems to be increased by bacteria in the intestine and any increase in the thickness or calories of the feedings.  The lining loses its blood flow or develops an infection and babies who are ill or premature don't have the immune systems and capability to fight this off on their own.  Their feedings need to be stopped, antibiotics need to be started and they needed to be watched carefully.

NEC remains the most common and severe intestinal conditions seen in prematures, affecting 7 percent of the infants born at 3 pounds or less.  Neonatologists (the doctors who take care of sick premies until they are able to leave the hospital) found that small tube feedings delivered directly into the stomach was better than intravenous (IV) nutrition.  These feedings (called trophic feedings) actually stimulate intestinal development in particularly vulnerable, smaller infants.  They begin with 1 teaspoon of formula or breastmilk dripped in over a few hours.  They then advance slowly and carefully to larger nutritious feedings.

A Delicate Balance

The goal is to return each baby to the growth rate her had in the womb (his intrauterine growth rate) and to match the amount of the various nutrients he was acquiring, particularly for critical nutrients like protein, calcium, and phosphorus.  At first, this can require IV nutrition, but when the baby seems healthy enough, the trophic feedings are added by tube (since these babies are too weak and lack the coordination to swallow effectively).  As the tube feedings are advanced, the IV is slowly weaned.

Preventing NEC

Breast milk as the first food appears to give the greatest protection when feedings are established.  The full reason isn’t certain. It may be due to breast milk's lower density, its immune factors, or the bacteria that are naturally in breast milk.  Commercial probiotics have been repeatedly tested, but with inconsistent results.

Trophic feedings and their cautious advancement are the current best recommendations available.  New trials are under way using lactoferrin, one of the natural immune factors within breast milk, but it is still too early to predict whether it will work. will try to keep you updated on the research results of this and other trials or you can follow on the National Institutes of Health or other medical sites that track clinical trials.

Dr. Stan Cohen 27 October 2015

Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr. Stan is an internationally recognized expert in pediatric gastroenterology and nutrition. He is a Read More

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