Learn About Necrotizing Enterocolitis
Necrotizing enterocolitis (NEC) is the death of tissue in the intestine. It occurs most often in premature or sick babies.
NEC occurs when the lining of the intestinal wall dies. This problem nearly always develops in an infant who is ill or premature. It is likely to occur while the infant is still in the hospital.
The exact cause of this disorder is unknown. A drop in blood flow to the bowel can damage the tissue. Bacteria in the intestine may also add to the problem. Also, premature infants have an undeveloped immune response to factors such as bacteria or low blood flow. An imbalance in immune regulation appears to be involved in NEC.
Babies at higher risk for the condition include:
- Premature infants
- Infants who are fed formula rather than human milk. (Human milk contains growth factors, antibodies, and immune cells which may help prevent the problem.)
- Infants in a nursery where an outbreak has occurred
- Infants who have received blood exchange transfusions or have been seriously ill
Symptoms may come on slowly or suddenly, and may include:
- Abdominal bloating
- Blood in the stool
- Diarrhea
- Feeding problems
- Lack of energy
- Unstable body temperature
- Unstable breathing, heart rate, or blood pressure
- Vomiting
Treatment for a baby who may have NEC most often includes:
- Halting enteral (GI tract) feedings
- Relieving gas in the bowel by inserting a tube in the stomach
- Giving intravenous (IV or into a vein) fluids and nutrition
- Giving IV antibiotics
- Monitoring the condition with abdominal x-rays, blood tests, and measurement of blood gases
The infant will need surgery if there is a hole in the intestines or inflammation of the abdominal wall (peritonitis).
In this surgery, the surgeon will:
- Remove dead bowel tissue
- Perform a colostomy or ileostomy
The bowel may be reconnected after several weeks or months when the infection has healed.
Steven Mcelroy is a Neonatologist and a Pediatrics provider in Sacramento, California. Dr. Mcelroy is rated as an Elite provider by MediFind in the treatment of Necrotizing Enterocolitis. His top areas of expertise are Necrotizing Enterocolitis, Premature Infant, Viral Gastroenteritis, and Patent Ductus Arteriosus.
Rubenstein Child Health Building
David J. Hackam, M.D., Ph.D., is the Garrett Family Professor of Pediatric Surgery at The Johns Hopkins University, and Pediatric Surgeon-in-Chief and co-Director of the Johns Hopkins Children’s Center. Dr. Hackam’s clinical practice focuses on complex neonatal surgery. As pediatric surgeon in chief and co-director of the Childrens Center, Dr. Hackam oversees all perioperative clinical operations that involve children, with a strong emphasis on quality and safety, programmatic growth, and system alignment. Dr. Hackam's research is focused on unraveling the mechanisms of necrotizing enterocolitis, which is the leading cause of death in premature infants from gastrointestinal disease. His work has identified a series of novel pathways that, in response to the abnormal microflora that characterizes the premature intestine, leads to intestinal mucosal barrier breakdown, bacterial translocation, mesenteric vasoconstriction, and NEC. In seeking to translate these findings to clinical studies, we have developed a family of molecules that can prevent NEC development, and which have in part been licensed for clinical development. In additional work, Hackam has developed a prototype artificial intestine, derived from patient-specific intestine stem cells, which we have implanted into pre-clinical models, for the treatment of short bowel syndrome, a devastating complication of NEC. Finally, using single-cell RNA-seq and cell tracking technology, Hackam has worked towards understanding and treating NEC-associated brain injury, a major complication of NEC, and has engineered nanoparticle-packaged molecules that can cross the blood-brain barrier, and reverse the processes that lead to this disease. These studies are funded by three ro1s, a T32, a MIRA (a maximizing investigators’ research award) and 3 industry grants from companies with an interest in NEC treatment and prevention. Dr. Hackam seeks to work with industry partners, as well as nurses, doctors, and families of patients around the country, in order to develop novel regimens to safely and effectively deliver appropriate nutrition to the most vulnerable infants, who are at risk for the development of intestinal disease. Dr. Hackam is rated as an Elite provider by MediFind in the treatment of Necrotizing Enterocolitis. His top areas of expertise are Necrotizing Enterocolitis, Necrosis, Short Bowel Syndrome, Pancreaticoduodenectomy, and Hepato-Pancreato-Biliary Surgery.
UPMC Susquehanna Health, Pediatrics
Toby Yanowitz is a Neonatologist in Williamsport, Pennsylvania. Dr. Yanowitz is rated as an Elite provider by MediFind in the treatment of Necrotizing Enterocolitis. Her top areas of expertise are Necrotizing Enterocolitis, Intraventricular Hemorrhage of the Newborn, Premature Infant, and Neonatal Sepsis.
NEC is a serious disease. Up to 40% of infants with NEC die from it. Early, aggressive treatment can help improve the outcome.
Complications may include:
- Peritonitis
- Sepsis
- Intestinal perforation
- Intestinal stricture
- Liver problems from prolonged inability to tolerate enteral feeds and need for parenteral (IV) nutrition
- Short bowel syndrome if a large amount of intestine is lost
Get emergency medical care if any symptoms of necrotizing enterocolitis develop. Infants who are hospitalized for illness or prematurity are at higher risk for NEC. They are watched closely for this problem before they are sent home.
Summary: This is a prospective in vitro cell biology study of polymorphonuclear leukocyte (PMN) protein synthesis in response to PAF. PMNs from cord blood of premature human infants at risk for NEC (birth weight between 501 - 1500 grams) and PMNs from cord blood of healthy term infants will be isolated and stimulated with PAF, a biologically active phospholipid implicated in the pathogenesis of NEC. NEC, a...
Summary: The WHEAT International trial is a comparative effectiveness trial exploring whether withholding enteral feeds around the time of blood transfusion in very premature infants (\<30 weeks) will reduce the occurrence of Necrotizing Enterocolitis (NEC). Currently both continued feeding and withholding feeding are approved care practices. The current study will randomize infants from Neonatal Intensive...
Published Date: April 06, 2025
Published By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
de la Cruz D, Neu J. Neonatal necrotizing enterocolitis. In: Martin RJ, Fanaroff AA, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 89.
Greenberg JM, Narendran V, Brady JM, Nathan AT, Haberman BB. Neonatal morbidities of prenatal and perinatal origin. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 73.
Maqbool A, Liacouras CA. Normal development, structure, and function of the stomach and intestines. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 374.