Necrotizing enterocolitis (NEC) is an intestinal infection that primarily affects premature infants shortly after beginning of feeds and affects approximately 7% of premature infants. Although the exact pathogenesis of this disease process is not known, the current prevailing theory is that infants who are fed and develop some other insult during their NICU coarse, such as respiratory or cardiac insufficiency, develop marginal blood flow to their intestine as a result of this insult. This marginal blood flow can lead to necrosis, or death, of the inner mucosal lining of the intestine and allows bacteria to get into the wall of the intestine. This can produce the characteristic sign of “pneumatosis intestinalis,” which means air in the bowel wall. Once bacteria get into the bowel wall, the infection can spread and lead to blood pressure and respiratory instability and sepsis. Early diagnosis—which includes early suspicion for NEC—is critical since the infection can typically be effectively treated by stopping feeds and starting antibiotics before the infection has spread.
This infant had several possible early warning signs of NEC, including temperature instability, episodes of apnea and bradycardia, bilious emesis, and periumbilical erythema at several times during his hospitalization. In fact, all of the above symptoms fit under the classification of Stage IA NEC, which is defined as suspected NEC. Due to the extremely high morbidity and mortality associated with NEC, early treatment with feeding cessation and broad-spectrum antibiotics must be used. The infant should also have nasogastric/orogastic suctioning to prevent over-distention of the intestines. Abdominal x-rays are required to assess for free air. A finding of free air means that the NEC has progressed to full thickness necrosis of the intestinal wall and mandates surgical intervention.
Necrotizing Enterocolitis (NEC) medical expert witness specialties include pediatric gastroenterology, pediatric surgery, pediatric infectious disease, neonatology, and pediatric critical care.