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Necrotizing Enterocolitis (NEC)

Necrotizing enterocolitis (NEC) is a neonatal bowel disease that can cause a hole to develop in an infant’s intestine, allowing its contents to spill into their abdomen. While NEC affects 1 in 10,000 full-term babies, premature children are ten times more likely to contract the disease. According to a 2017 review published in the journal Advances in Nutrition, children born before 32 weeks, weighing less than 1,500 grams, and experiencing cardiac complications are the most at-risk for developing NEC.

Premature children are more susceptible because their immune systems are still developing. However, NEC risk factors include some that are unrelated to birth weight or term. Studies show that consuming formula made from cow’s milk can expose already immunocompromised preterm children to an even greater risk of NEC.

If you believe your baby’s formula caused them to develop necrotizing enterocolitis, the Birth Injury Center can help you. Our mission is to help the families of children with birth injuries find the resources they need to move forward. Contact us today to schedule a free consultation for legal assistance.

What is NEC?

Necrotizing enterocolitis is a condition that kills the tissue of the intestinal wall, sometimes resulting in the perforation of an infant’s bowels. The perforation (hole) allows the contents of the intestine to leak into the stomach or bloodstream.

There are some simple treatment options, but more severe cases may require surgery, and advanced cases may not be treatable.

NEC usually develops between 2 and 6 weeks after the baby is born. Common symptoms of the disease include:

Failure to eat or gain weight

One of the first indicators of NEC is a child’s frustration with feeding. In contrast to most healthy babies, infants with NEC will resist feeding due to discomfort.

Abdominal pain or swelling

Because NEC causes inflammation in the abdomen, the child’s stomach may appear swollen or distended.

Diarrhea with bloody stool

Disturbed feeding routines and habits combined with inflamed bowels can result in loose, bloody stool.

Green or yellow vomit

Bile may back up into the stomach from the liver due to digestive disruption.

Irregular heart rate, blood pressure, body temperature, or breathing, and lack of energy

These are common signs of general infection that NEC presents.

The symptoms of NEC are very similar to those of other digestive conditions, many of which are more common than NEC. If you believe your child has or had NEC, seek a diagnosis from your child’s doctor.

What causes an infant to develop NEC?

Unfortunately, pathologists have yet to determine a singular cause of NEC. The nature of the disease makes it challenging to research. However, studies have established a link between NEC and certain risk factors.

Premature Birth

Newborns are sensitive and delicate. Their immune systems and bodily functions have just begun to work without their mother’s support.

In this fragile state, newborns have difficulty fighting infection. The baby’s digestive system has yet to gain the strength to defend itself. Preterm babies’ less developed systems make them more susceptible to NEC and other diseases.

Formula Feeding

Several studies have demonstrated that babies who consumed formula made from cow’s milk have a greater risk of developing necrotizing enterocolitis than those who consumed human breast milk. Scientists are not yet sure why, but they do theorize that bovine-based formulas lack the carbohydrates present in human breast milk that prevent the growth of inflammatory pathogenic microbiota — bacteria that causes disease.

Difficult Birth or Low Oxygen at Birth

Circulation to the intestines is poor when children are very young because the newborn’s circulatory system prioritizes their brain and heart. Since the intestines are already receiving little oxygen, any reduction in oxygen delivery can compromise intestinal tissues. This makes the child even more vulnerable to infection in the area.

Which baby formulas use cow’s milk?

Parents who know cow’s milk-based formulas can increase their child’s risk of contracting NEC are alarmed to learn that most formulas contain cow’s milk.

In recent months, dozens of product liability claims have been filed against two popular cow’s milk-based baby formula brands. These plaintiffs accuse the makers of Enfamil and Similac of negligently marketing their products to the parents of newborns, ignoring the risks associated with cow’s milk in baby formula.

Other common bovine-milk-based formulas include:

  • Gerber
  • Earth’s Best
  • Happy Baby
  • Go & Grow
  • Up & Up
  • Parent’s Choice
  • Kirkland Signature

Cow’s milk-based products are inexpensive, making them a popular — but harmful — alternative to breast milk.

How do doctors diagnose necrotizing enterocolitis?

In addition to monitoring for signs of infection, physicians can diagnose necrotizing enterocolitis in many ways, including:

Fecal tests

Doctors can assess your child’s stool for blood.

Blood tests

Byproducts of the bacteria that cause NEC can reduce platelet levels, and doctors can see evidence of dying tissue if they find too much acid in the baby’s blood. The infection itself can also show itself in an irregular white blood cell count.


Physicians look for air inside the bowel wall, in the vein from the bowels to the liver, or inside the stomach but outside the bowels, as well as fluid inside the stomach and swollen loops of intestines that don’t move.

Source: Seattle Children’s Hospital

Treatments for Necrotizing Enterocolitis

A physician’s first line of defense against NEC is to put the child on an intravenous feeding schedule as soon as they diagnose the disease. The sooner the baby’s bowels can rest, the more quickly they can heal.

Children’s Hospital Los Angeles notes that appropriate treatment plans depend on the degree of the damage. Children with milder cases of NEC may need short-term treatment. More severe illness may require multiple surgeries and several weeks between them in recovery.

Some NEC treatment options include:

Healthcare providers insert a nasogastric tube to carry medicine and food to the infant’s stomach while preventing air from filling the stomach and intestines.
Antibiotics directly combat infections caused by bacteria. According to Seattle Children’s Hospital, infants with NEC typically need a 10- to 14-day course of antibiotics.
Just as they use X-rays and blood tests to diagnose NEC, doctors use them to monitor the effectiveness of NEC treatments.
NEC may cause abdominal swelling, making it harder for babies to breathe. In these cases, doctors use artificial means to assist the child’s respiration.
Vulnerable preterm infants are exposed to infection-causing bacteria, increasing the risk that they will contract other diseases. To protect these babies, doctors may keep them in quarantine as they receive treatment.

According to Cleveland Clinic, roughly 25% of children with NEC require surgical intervention. To treat NEC, surgeons remove the damaged tissue from the child’s intestines, saving and repairing as much as possible. Surgeons may also perform an ostomy, which creates a pathway called a stoma that passes from the intestine through the skin, to allow waste to exit the body. Very low birth weight babies may need interim catheters to drain fluid as they gain enough strength for surgery.

Statistically, 80% of babies

afflicted with NEC survive the infection. However, the disease will leave some survivors with recurring, lifelong health problems.

What are the potential long-term effects of NEC?

NEC complicates life for many of its survivors. Children who require surgery are especially vulnerable to long-term consequences. Experts at Cleveland Clinic have associated NEC with these potential future medical issues.

Abdominal Infection

NEC’s initial infection opens the door for a chain reaction of related conditions. The intestinal necrosis can result in bowel perforations, giving bacteria access to the abdominal cavity. The bacteria can give rise to inflammation of the abdominal lining, called peritonitis. Peritonitis increases the child’s risk of developing sepsis.

Intestinal Stricture

About a third of children who recover from NEC develop intestinal strictures. Strictures thin the intestinal passageways and make it difficult for food to pass through them. Children recovering from NEC may need intestinal strictures surgically reopened to digest their food properly.

Short gut syndrome

Necrotizing enterocolitis can kill intestinal tissue, so the disease may leave the child with only a partially functioning digestive tract. NEC survivors may have difficulty absorbing nutrients from food. This condition is called short gut syndrome, and it can follow NEC survivors throughout their lives.

Growth failure and developmental delays

Children need nutrients to grow. Because NEC attacks the organ responsible for nutrient absorption, the disease can effectively hinder a child’s development. Survivors of NEC may need regular specialized treatments to maintain proper growth.

What should I do if I suspect my baby has or had NEC?

No family or child should have to experience the pain and fear of necrotizing enterocolitis, but you don’t have to go through any of this alone.

If you believe your baby’s formula caused them to develop necrotizing enterocolitis, the Birth Injury Center is here to help. Our team can walk you through the legal process and help you obtain compensation for your losses. Contact us today to schedule a free consultation for assistance with a potential NEC lawsuit.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.