Necrotizing enterocolitis (NEC) is a condition that affects between 1 in every 2000 and 1 in every 4000 premature infants. It occurs mostly in formula-fed babies within their second or third week of life. Near-term and full-term babies may also develop NEC, which is characterized by a damaged intestinal tract. The damage may be as simple as a mucosal injury, or as serious as necrosis and perforation. The mortality rate for NEC is approximately 50%. Parents of premature infants, in particular, should be on the watch for the symptoms of necrotizing enterocolitis.

Feeding Intolerance

Infants with NEC often have difficulty tolerating formula. Parents, nurses, and doctors may try sensitive formula or formula with alternatives to cow’s milk, such as goat’s milk or soy and find the infant still shows intolerance. Signs of feeding intolerance include crying during or after a feeding, gagging while feeding, gas, excessive spitting up or vomiting. In severe cases, doctors may opt to replace bottle feeding with a feeding tube to ensure the infant receives adequate nutrition.

Failure to Thrive

Babies who have been diagnosed with failure to thrive, especially premature babies, should be watched for other signs of NEC. Symptoms of failure to thrive include a lack of appropriate weight gain, irritability and fussiness, excessive sleepiness, and tiring quickly after very little activity. Failure to thrive may occur despite the parents’ best efforts to ensure weight gain and comfort, and care for their infant appropriately.

High Level of Gastric Residuals

If a doctor suspects an infant has a feeding intolerance, he or she may recommend checking gastric residuals, the fluids that remain in the stomach after a feeding. If a high level of fluid is lingering in the stomach, this means the infant has a high level of gastric residuals. This may indicate feeding intolerance and NEC. Infants fed via feeding tube are more susceptible to this symptom.

Abdominal Distension

Abdominal distension occurs when fluids or gases become trapped in the abdomen, causing severe bloating and swelling. In an infant with abdominal distension, the stomach may appear larger than the rest of the body and the infant may display signs of pain or discomfort. In NEC, this symptom is usually accompanied by a feeding intolerance.

Diarrhea

Diarrhea is often one of the first noticeable symptoms in infants with necrotizing enterocolitis. Because infant stools aren’t typically solid, it may be difficult to notice the presence of diarrhea. The best way to determine if diarrhea is present is by analyzing dirty diapers. If stool has been absorbed by the diaper, then diarrhea is present, while stool that sits on the surface is of normal consistency.

Blood in the Stool

The sight of blood in an infant’s diaper can be alarming. Blood may appear as red streaks in the stool, or as thick, black stool. It is important to remember infants pass black, tarry stools called meconium in their first days of life. Meconium is not a cause for concern and does not contain blood.

Abdominal Discoloration

Infants with NEC may experience discoloration on the abdominal skin. The skin may appear to turn dark pink, deep red, blue, or even bruised, and veins may show through the skin. Abdominal discoloration usually presents shortly after the infant has experienced bloating and discomfort associated with abdominal distension.

Peritonitis

Peritonitis is inflammation of the inner wall of the abdomen. In infants, signs of peritonitis include bloating and fussiness or irritability indicating discomfort or pain. Fever and weight loss may also be present in infants with peritonitis, and upon examination, doctors may find tender spots in the abdomen.

Hypotension

In the advanced stages of necrotizing enterocolitis, infants usually experience hypotension or low blood pressure. Signs of hypotension include dizziness or lightheadedness, nausea, vomiting, and fatigue or lethargy. In infants, these signs present as fussiness and irritability, refusal to eat, and a lack of energy. A nurse or doctor will check an infant’s blood pressure to confirm hypotension.

Lethargy and Crankiness

Infants with necrotizing enterocolitis usually alternate between periods of extreme lethargy and fatigue and extreme levels of crankiness and irritability. Although both can be signs of many other problems or just normal stages of infancy, it’s important to watch for these alternating symptoms and discuss their occurrence with a doctor.