Children and families |
Necrotising enterocolitisThis section explains about necrotising enterocolitis, how it is treated and what to expect when your child comes to Great Ormond Street Hospital for treatment. Contents
What is necrotising enterocolitis?Necrotising enterocolitis (NEC) is a serious illness in which tissues in the intestine (gut) become inflamed and start to die. This can lead to a perforation (hole) developing which allows the contents of the intestine to leak into the abdomen (tummy). This can cause a very dangerous infection. NEC can be difficult to diagnose but the symptoms tend to include general signs of illness, problems feeding, and a swollen and tender abdomen. NEC is the most common surgical emergency in newborn babies and tends to affect more babies born prematurely than those born full-term. NEC seems to becoming more common, but it is likely that this is because more premature babies are surviving.
How is it treated?In most cases, NEC can be treated without surgery, by resting the intestine by using intravenous feeding and treating any infection with medication. During this period, your child will have a naso-gastric (NG) tube passed through his or her nose to drain off the contents of his or her stomach. He or she will also have an intravenous infusion (drip) of fluids and medicines. However, your child will need an operation if he or she develops a perforation, does not respond to the treatment above, or their intestine becomes narrowed with scar tissue (strictures). The operation is carried out under a general anaesthetic (so your child is deeply asleep) and can last between 30 minutes and four hours depending on the severity of the NEC. What happens before the operation?The surgeon will explain about the operation in more detail, discuss any worries you may have and ask you to sign a form giving consent for your child to have the operation. An anaesthetist will visit you to explain about the anaesthetic. What does the operation involve?The surgeon will remove any parts of the intestine where tissue has died. The amount removed can vary, but the surgeons will leave as much of the intestine as possible. If the surgeons have to remove a large part of the intestine, they may need to create an artificial way of disposing of waste matter, called a ‘stoma’. If you child is likely to need a stoma, the stoma care nurse specialist will visit you to explain further. Are there any risks?All the doctors who perform this operation have had lots of experience and will minimise the chance of problems occurring. All surgery carries a small risk of bleeding during or after the operation. Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is a very experienced doctor who is trained to deal with any complications. What happens afterwards?Your child will come back to the ward to recover, and you will be able to visit as soon as he or she is settled back in the incubator. For a while after the operation, your baby will need help with breathing so will be connected to a ventilator. All babies are closely monitored after the operation, and so your child will be connected to monitors to check his or her breathing, heart rate and oxygen levels. He or she will also be given pain relief through the intravenous infusion (drip). While your child’s intestines recover and start to work, he or she will continue to be fed through a tube into his or her veins (total parenteral nutrition or TPN). This will gradually be replaced by breast or bottled milk given through the naso-gastric (NG) tube, when your child is ready for this. As your child recovers, you will be able to feed him or her from the breast or bottle. Over time, the drips and monitors will be removed one by one. The nurses on the ward will encourage you to look after your child as much as you feel able while he or she is recovering. This can be daunting, especially while they are connected to drips and monitors, but it will become easier with time. If you are worried about caring for your child, please talk to the nurses. Your child will be transferred to another ward within the hospital or to your local hospital, once he or she is feeding properly and gaining weight. We will send you details of your outpatient appointment in the post, soon after you leave hospital. What is the outlook for children with NEC?When NEC is successfully treated by resting the intestine, the outlook is good with most children growing up to lead normal lives. For children who have had surgery, the outlook depends on the amount of intestine removed and how prematurely your child was born. If your child had a large amount of intestine removed, he or she may need to stay on TPN for a longer period, sometimes for a year or longer, until the intestine can absorb enough nutrients for normal growth and development. In an emergencyYou should call your hospital if you are concerned or your baby develops any of the following symptoms:
The doctors there will discuss any concerns with the team at Great Ormond Street Hospital. Is there a support group?There is no support group specifically for babies with NEC, but the following organisation may be able to help:
BLISS
Ref: F020140 © GOSH Trust December 2002 This page was last updated on 12 August, 2008 |
UCL Institute of Child Health
Great Ormond Street Hospital for Children NHS Trust
