What Should Parents Know About Necrotizing Enterocolitis?

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Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is an intestinal disease that can be devastating for premature infants. The wall of the large intestine, the colon, becomes infected and inflamed and can lead to perforations that allow spillage of stool into the baby’s abdomen. The result can be a massive and fatal infection if symptoms are not recognized and quickly treated. Although most infants recover fully from NEC, in severe cases some have lasting trouble absorbing nutrients, while others require intestinal transplants. In rare cases, the infant cannot fight the infection and does not survive.

Families whose newborn has been injured because of negligent care should reach out to an experienced birth injury lawyer for assistance.

What Causes NEC?

NEC is rare in infants born at full term but occurs in almost 10 percent of premature infants. Doctors still do not know what causes NEC, but the two consistent factors in the infants who are affected are formula feeding and premature birth. Premature infants may be more susceptible because of their immature lungs and intestines. Low oxygen levels at birth or a difficult birth may also contribute to a baby developing NEC. Low levels of oxygen cause the body to direct blood and oxygen to the brain and heart first, leaving a reduced flow of blood to the intestinal tract. A decrease in oxygen delivery to the colon will damage the lining of the intestinal wall, allowing bacteria to escape and cause infection and inflammation.

What are Common Symptoms of NEC?

NEC generally develops within the first two week of an infant’s life. Typically, the infant is being fed with formula instead of breast milk, and one of the first indications of NEC is the inability to tolerate feedings. Symptoms that coincide with this are abdominal distention or bloating and discoloration, and green vomit that contains bile. Additional symptoms at this early stage may include bloody stools indicating infection of the bowel wall, and food that cannot move through to the intestines causing blockages.

As the infection progresses, the infant may experience a low respiratory rate; lethargy; slow heart rate; and breathing that starts and stops, termed apnea.

Some symptoms of NEC may be mistaken for symptoms of other conditions. If NEC is not correctly diagnosed quickly, the infection can spread and be much more difficult to treat successfully.

How Will the Doctor Know if My Baby Has NEC?

The medical professionals working with premature infants should know and recognize the symptoms of NEC. Failure to do so can jeopardize a baby’s health and even be fatal. Doctors can check for the signs of NEC and confirm a diagnosis by ordering abdominal X-rays. X-rays will show the condition of the intestine and if the wall has a bubbly appearance, an indication of damage. The X-ray may also show if there is air on the outside of the intestine or in the large veins of the liver.

The doctor can also use a needle to look for intestinal fluid in the infant’s abdominal cavity. Finding intestinal fluid outside the intestinal wall is a sign that the intestine is damaged and leaking.

Tests of the infant’s blood can be performed to check on the levels of platelets and white blood cells. Platelets help to form blood clots and prevent bleeding, whereas white blood cells help the body defend itself against bacterial infections. Reduced levels of platelets and white blood cells mean the infant’s risk of bleeding and serious widespread infection is at a higher level.

How is NEC in Infants Treated?

The method of treatment for NEC depends on the severity of the condition, the age of the infant, the symptoms presented, and the infant’s general health. Initial treatment may include the following steps:

  • Keeping the stomach empty; feedings are discontinued, and sometimes an orogastric tube is inserted to remove air and fluid from the stomach and intestine
  • Administering fluids and antibiotics through an intravenous (IV) line
  • Administering extra oxygen or using a breathing machine if the infant’s swollen abdomen interferes with breathing
  • Isolating the infant to prevent the spread of infection


Frequent checks and X-rays of the abdomen will also be performed to determine the progression of the infection. It may take five to seven days to see improvement in some infants, whereupon oral feedings can resume. A more severe infection may require a longer course of treatment for the infant to return to normal bowel function. If treatment through medicines is unsuccessful and the condition worsens, surgery is necessary to find and remove the damaged portions of the intestine.

During surgery for severe cases of NEC, the piece of intestine that has ruptured, is about to rupture, or is already dead or necrotic, is removed. Great care is taken to try to preserve as much of the intestine as possible. The abdominal cavity may also be drained at this time. For very sick infants, an ostomy may be performed, which temporarily connects part of the intestine or bowel to an opening on the abdomen until the infant has recovered from the infection.

Recovering from NEC

When infants are able to feed again safely, it is highly recommended that only breast milk be given, as it is more easily digested, boosts immunity in infants, and supports the growth of healthy bacteria in the intestinal tract. Most infants recover fully from NEC and do not have further problems. Some babies may have scarring or narrowing of the bowel afterward, which can lead to future blockage or obstruction of the intestine. Others, especially those who had part of their intestine removed, may have a lasting condition called malabsorption. This means the intestine has trouble absorbing nutrients. In rare cases, an infant loses so much intestine to the infection that a bowel transplant is necessary to survive.

Medical Malpractice and NEC

NEC is easily treated without surgery for most infants when it is diagnosed swiftly and treated immediately. Any delayed or incorrect diagnosis can give the infection time to spread, making it more likely that the condition will require surgery. The medical professionals caring for premature infants should know and recognize the symptoms of NEC so that the condition is diagnosed, treated, and not allowed to progress. Failure to do so could be grounds for a medical malpractice lawsuit if the standard of medical care is not met.

A claim of medical malpractice can be made when the standard of medical care is violated and results in an injury. The standard of care refers to the kind of care that would be expected from any similar health care provider under the same or similar circumstances. The injury suffered must be the result of the health care provider’s negligent behavior. A claim cannot be made if there was no injury or the injury was not the direct result of the breach in the standard of care. Consultation with an experienced medical malpractice or birth injury lawyer can help determine if grounds for a malpractice suit are viable.

What Kind of Damages are Available in Medical Malpractice Suits?

A successful medical malpractice suit may recover some or all of the following kinds of damages:

  • Medical costs associated with the illness as well as costs for long-term care
  • Pain and suffering
  • Income loss of parents
  • Loss of quality of life
  • Loss of enjoyment of life
  • Death benefits for families that lose a loved one


Medical negligence is disturbing in all cases, but for parents of a newborn baby, it can be terrible to think their child has experienced a trauma that was preventable. To prove a medical malpractice case, it is important to gather as much supporting evidence as possible. Medical records, witness accounts, personal notes, and photos can all help build a strong case to hold a negligent medical provider accountable. Anyone who suspects they have experienced substandard and negligent medical care should consult with a knowledgeable lawyer who can evaluate the circumstances of their case.

Baltimore Birth Injury Lawyers at LeViness, Tolzman & Hamilton Advocate for Victims of Medical Malpractice

If you believe your child suffered a birth injury as the result of negligent health care, contact the compassionate Baltimore birth injury lawyers at LeViness, Tolzman & Hamilton. Our team has more than 100 years of combined experience holding medical professionals accountable for their actions. We will evaluate your case and advise you of your best course of legal action. Call us at 800-547-4LAW (4529) or contact us online to schedule a free consultation.

Our offices are conveniently located in BaltimoreColumbiaGlen Burnie, and Prince George’s County, where we represent victims throughout Maryland, including those in Anne Arundel CountyCarroll