Necrotizing enterocolitis (NEC) is a gastrointestinal (GI) disease in which sections of the bowel become inflamed and begin to die. This can create a hole in the bowel, which allows bacteria to leak into the abdomen or bloodstream.

NEC occurs mostly in premature infants, but it can also develop in adults. The disease can be life threatening, but recovery is often possible with the right treatment.

This article outlines the different types of NEC and provides information on its symptoms, causes, and risk factors. It also describes how doctors diagnose and treat NEC and offers some tips on prevention.

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The NEC Society classifies NEC into the following five types:

  • Classic: This is the most common type of NEC. It affects premature infants aged 3–6 weeks. The symptoms develop within hours and may include:
  • Atypical: This type refers to NEC that develops in an unusual pattern, such as during the first week of infancy.
  • Term infant: This type develops in an infant born at term, meaning at 37–41 weeks gestation. It is rare, affecting about 1 in 10,000 full-term infants. The possible causes include an anomaly involving the heart or intestines and low oxygen levels before or during a difficult birth.
  • Transfusion-associated: This type develops in premature infants who have received a blood transfusion.
  • NEC outbreaks: Healthcare professionals use this term to refer to multiple cases of NEC in preterm infants within the same intensive treatment unit. Such outbreaks are uncommon and may be related to bacteria or viruses.

According to the National Institute of Child Health and Human Development (NICHD), possible symptoms of NEC include:

  • an inability to digest food
  • a swollen or bloated abdomen
  • pain when touching the abdomen
  • diarrhea
  • bloody stool
  • low heart rate

Some infants may also have a weak pulse, indicating a drop in blood pressure.

Researchers do not know the exact cause of NEC. However, the United Kingdom’s National Health Service (NHS) notes that the following factors may increase a baby’s risk of developing the disease:

The NICHD estimates that NEC affects about 9,000 premature infants per year in the United States.

However, as low birth weight can also be a risk factor for NEC, the increasing survival rate among low birth weight infants may result in an increase in the number of infants who receive a diagnosis of NEC.

Some individuals may require surgery to treat NEC. In some cases, surgeons may need to remove large sections of the bowel. The NHS explains that during the recovery process, the remaining bowel may narrow, making it difficult for the baby to pass stool.

In severe cases of NEC, bowel surgery is sometimes not successful, and the baby does not survive.

When diagnosing NEC, a doctor will begin with a physical examination to check for abdominal swelling and other symptoms.

They will also use one or more of the following tests to check for NEC:

  • Blood tests: If NEC is present, blood tests may indicate a decrease in the number of platelets and white blood cells. Platelets help prevent bleeding, and white blood cells provide protection against bacterial infections.
  • X-rays: An abdominal X-ray may show gas or air bubbles in the intestinal walls.
  • A fecal test: Testing the stool may help identify traces of blood that are not otherwise visible.

The NHS notes that babies with NEC may require a nasogastric feeding tube to enable the bowel to rest and heal.

They may also receive an IV infusion of fluids and antibiotics. Doctors typically administer a combination of three antibiotics for up to 10 days.

According to the NICHD, many infants respond to treatment within 72 hours. If the infant does not show signs of improvement or develops a perforated bowel, they may need surgery to remove the affected bowel tissue. The surgery involves general anesthesia and may take several hours.

After the surgery, the infant may need a ventilator to help them breathe. Doctors will constantly monitor the infant’s heart rate and oxygen levels and provide IV pain relief.

NEC is more common among preterm babies. The NICHD lists factors that may increase a person’s chances of having a preterm birth. These include:

The following may help reduce the likelihood of a preterm birth:

An older 2004 study reported on four cases of NEC in adult males aged 35–55 years. The researchers identified the following common factors:

Symptoms and complications

In the 2004 case study, some of the symptoms that occurred were:

The study notes that NEC in adults may cause both acute and delayed complications.

Acute complications may include:

Delayed complications may include:


The treatment for adults with NEC is similar to that for infants. However, some adults may also require treatment for comorbid conditions, such as anemia or hypotension.

NEC is more common among preterm infants. As such, a person should consult their doctor or midwife if they believe that they have an increased chance of experiencing preterm labor. Healthcare professionals can prescribe treatments or suggest preventive measures to help reduce complications during the pregnancy.

The NHS recommends calling the maternity unit if possible signs of preterm labor develop. These signs include any of the following prior to the 37th week of pregnancy:

  • back pain
  • period-like cramps
  • regular contractions
  • trickling or gushing fluid from the vagina

NEC is a life threatening condition involving inflammation of the bowel tissue.

Preterm infants have an increased risk of developing NEC. Anyone who has a higher likelihood of delivering a preterm infant should talk with their doctor or midwife about ways to help prevent preterm labor.

Most infants and adults with NEC recover following prompt and appropriate treatment. The NHS states that most children who receive treatment in the form of bowel rest and antibiotics go on to lead normal and healthy lives.

Children who undergo more extensive bowel surgery may require tube feeding until their remaining bowel is able to absorb the necessary amount of nutrients for normal growth and development.

In cases of severe disease, an individual may not survive, even after surgery.

Necrotizing enterocolitis is a gastrointestinal disease involving inflammation and damage to sections of bowel tissue. The condition mostly affects premature infants. However, older children and adults can also develop the disease.

The treatment for NEC typically involves a feeding tube to allow the bowel to rest and heal. Doctors may also offer antibiotic medications. Individuals with worsening NEC or a perforated bowel may require surgery to remove the damaged bowel tissue.

As NEC is most common among preterm infants, people with known risk factors for preterm delivery should talk with their doctor about ways to help prevent early labor.