Neonatal Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a serious inflammatory disease of the neonatal intestine, characterized by variable degrees of mucosal injury, intestinal necrosis and systemic inflammation. It occurs predominantly in premature and very-low-birth-weight infants, although it may also affect term newborns with particular risk factors. It is not simply poor feed tolerance. A useful mental model has three steps: a vulnerable bowel, an injury to its lining, and a systemic response. Everything the nurse sees at the bedside fits one of those steps, and the danger lies in how quickly an infant can move from the first to the third. The condition can progress rapidly from feeding intolerance and abdominal distension to intestinal perforation, septic shock and multiorgan dysfunction. A mildly distended abdomen can become a surgical emergency within hours when bowel perfusion worsens or perforation occurs. That speed is why a premature newborn with new abdominal distension, bloody stool, feeding intolerance or systemic instability needs prompt assessment for NEC. Suspected NEC is time-sensitive: enteral feeds are withheld while urgent neonatal assessment and investigation proceed. ### Why the bowel is injured NEC...