A complex infection

Immature intestines at risk for destructive infection, inflammation

Kathy Whitney
Published: June, 2010

Steve McElroy, M.D.
Photo by Anne Rayner

Steve McElroy, M.D., assistant professor of Pediatrics at Vanderbilt University Medical Center, recalls the case of a baby girl born at 27 weeks and weighing 1,000 grams (2.2 pounds).

Like most premature babies, she had a history of eating intolerance. Her belly swelled and became tense, and she went into respiratory failure that required her to be intubated. When surgeons performed exploratory surgery, they discovered that only about 3 inches – 5 percent -- of her small bowel were viable. The cause was necrotizing enterocolitis.

 “The end result was we had to close this baby’s belly up, hand her to her parents and withdraw from care,” McElroy recalls.

Necrotizing enterocolitis (NEC) affects 1 percent to 3 percent of babies admitted to intensive care nurseries. Primarily a disease of prematurity, it affects one in 10 infants born weighing less than 1,500 grams (3.3 pounds).

The mortality rate is between 20 percent and 50 percent, which means about 2,700 infants die from necrotizing enterocolitis every year in the United States. Babies who survive have significantly increased risks of feeding problems, liver failure and developmental delays.

“The process happens very rapidly, and you can’t predict who it’s going to happen to,” says McElroy. “It often happens within 12 hours, and is a very devastating disease for these babies.

“We’ve known about this disease about as long as there have been neonatologists,” he continues. “We’re not any better at treating it today than we were back in the 1970s. Part of that is because it’s a very complex disease.

“While we have been studying it for half a century, we don’t fully understand it or why some babies get it and why some get it worse than others. It’s a disease process that’s ripe for investigation.”

Leopard spots

Necrotizing enterocolitis begins with an infection.

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