View source for Necrotizing enterocolitis

{{Short description|Intestinal disease affecting infants}}
{{Infobox medical condition (new)
| name          = Necrotizing enterocolitis
| synonyms      =
| caption       = Gross pathology of neonatal necrotizing enterocolitis. Autopsy of infant showing abdominal distension, intestinal necrosis and hemorrhage, and [[peritonitis]] due to perforation.
| pronounce     =
| field         = [[Pediatrics]], [[gastroenterology]], [[neonatology]]
| symptoms      = Poor feeding, bloating, decreased activity, [[vomiting]] of [[bile]]<ref name=Mer2017/>
| complications = [[Short-gut syndrome]], [[intestinal stricture]]s, [[Developmental disability|developmental delay]]<ref name=Ric2017/>
| onset         =
| duration      =
| types         =
| causes        = Unclear<ref name=Mer2017/>
| risks         = [[Preterm birth]], [[congenital heart disease]], [[birth asphyxia]], [[exchange transfusion]], [[prolonged rupture of membranes]]<ref name=Mer2017/>
| diagnosis     =
| differential  = [[Sepsis]], [[anal fissure]], [[infectious enterocolitis]], [[Hirschsprung disease]]<ref name=Ric2017/><ref>{{cite book| vauthors = Crocetti M, Barone MA, Oski FA |title=Oski's Essential Pediatrics|date=2004|publisher=Lippincott Williams & Wilkins|isbn=9780781737708|page=59|url=https://books.google.com/books?id=I3Kh1cNJxyUC&pg=PA59}}</ref>
| prevention    = [[Breast milk]], [[probiotics]].<ref name=Ric2017/>
| treatment     = [[Bowel rest]], [[nasogastric tube]], [[antibiotics]], surgery<ref name=Ric2017/>
| medication    =
| prognosis     = Risk of death 25%<ref name=Mer2017/>
| frequency     =
| deaths        =
}}
<!-- Definition and symptoms -->

'''Necrotizing enterocolitis''' ('''NEC''') is an intestinal disease that affects premature or very low birth weight infants.<ref name=":0">{{Cite journal |last1=Gephart |first1=Sheila M. |last2=Quinn |first2=Megan |date=October 2021 |title=A Call to Action to Fight for Equity and End Necrotizing Enterocolitis Disparities |url=https://journals.lww.com/10.1097/ANC.0000000000000940 |journal=Advances in Neonatal Care |language=en |volume=21 |issue=5 |pages=333–335 |doi=10.1097/ANC.0000000000000940 |pmid=34469364 |issn=1536-0903|url-access=subscription }}</ref><ref name=Mer2017/> Symptoms may include [[Dysphagia|poor feeding]], [[bloating]], decreased activity, [[Blood in stool|blood in the stool]], [[vomiting]] of [[bile]], [[Multiple organ dysfunction syndrome|multi-organ failure]], and potentially [[death]].<ref name=Mer2017/><ref name=Ric2017>{{cite journal | vauthors = Rich BS, Dolgin SE | title = Necrotizing Enterocolitis | journal = Pediatrics in Review | volume = 38 | issue = 12 | pages = 552–559 | date = December 2017 | pmid = 29196510 | doi = 10.1542/pir.2017-0002 | s2cid = 39251333 }}</ref>

<!-- Cause and diagnosis -->
The exact cause is unclear.<ref name=Mer2017/> However, several risk factors have been identified. Consistently described risk factors include [[Infant formula|formula feeding]], intestinal [[dysbiosis]], [[low birth weight]], and [[Premature birth|prematurity]].<ref>{{cite journal | vauthors = Rose AT, Patel RM | title = A critical analysis of risk factors for necrotizing enterocolitis | journal = Seminars in Fetal & Neonatal Medicine | volume = 23 | issue = 6 | pages = 374–379 | date = December 2018 | pmid = 30115546 | pmc = 6269219 | doi = 10.1016/j.siny.2018.07.005 }}</ref> Other risk factors potentially implicated include [[congenital heart disease]], [[birth asphyxia]], [[exchange transfusion]], and [[prelabor rupture of membranes]].<ref name=Mer2017>{{cite web|title=Necrotizing Enterocolitis – Pediatrics – Merck Manuals Professional Edition|url=http://www.merckmanuals.com/en-ca/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/necrotizing-enterocolitis|website=Merck Manuals Professional Edition|access-date=12 December 2017|date=February 2017}}</ref> The underlying mechanism is believed to involve a combination of [[ischemia|poor blood flow]] and [[infection]] of the intestines.<ref name=Ric2017/> Diagnosis is based on symptoms and confirmed with [[medical imaging]].<ref name=Mer2017/>

Maternal factors such as [[chorioamnionitis]], [[Cocaine dependence|cocaine abuse]], [[intrauterine growth restriction]], [[Intrahepatic cholestasis of pregnancy|intrahepatic cholestasis during pregnancy]], increased [[body mass index]], lack of prenatal steroids, mode of delivery, [[placental abruption]], [[pre-eclampsia]], and [[smoking]] have not been consistently implicated with the development of NEC.<ref>{{cite journal |vauthors=Travers CP, Clark RH, Spitzer AR, Das A, Garite TJ, Carlo WA |date=March 2017 |title=Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study |journal=BMJ |volume=356 |pages=j1039 |doi=10.1136/bmj.j1039 |pmc=5373674 |pmid=28351838}}</ref><ref>{{cite journal |vauthors=Been JV, Lievense S, Zimmermann LJ, Kramer BW, Wolfs TG |date=February 2013 |title=Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis |journal=The Journal of Pediatrics |volume=162 |issue=2 |pages=236–42.e2 |doi=10.1016/j.jpeds.2012.07.012 |pmid=22920508 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Lu Q, Cheng S, Zhou M, Yu J |date=April 2017 |title=Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study |journal=Pediatrics and Neonatology |volume=58 |issue=2 |pages=165–170 |doi=10.1016/j.pedneo.2016.04.002 |pmid=27543379 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Czyrko C, Del Pin CA, O'Neill JA, Peckham GJ, Ross AJ |date=April 1991 |title=Maternal cocaine abuse and necrotizing enterocolitis: outcome and survival |journal=Journal of Pediatric Surgery |volume=26 |issue=4 |pages=414–8; discussion 419–21 |doi=10.1016/0022-3468(91)90988-6 |pmid=2056401 |doi-access=free}}</ref><ref>{{cite journal |display-authors=6 |vauthors=Downard CD, Grant SN, Maki AC, Krupski MC, Matheson PJ, Bendon RW, Fallat ME, Garrison RN |date=July 2012 |title=Maternal cigarette smoking and the development of necrotizing enterocolitis |journal=Pediatrics |volume=130 |issue=1 |pages=78–82 |doi=10.1542/peds.2011-3808 |pmid=22689867 |s2cid=17281723}}</ref>

<!-- Treatment and prognosis -->
Prevention includes the use of [[breast milk]] and [[probiotics]].<ref name=Ric2017/> Treatment includes [[bowel rest]], [[orogastric tube]], [[intravenous fluids]], and intravenous [[antibiotics]].<ref name=Ric2017/> Surgery is required in those who have [[pneumoperitoneum|free air in the abdomen]].<ref name=Ric2017/> A number of other [[supportive care|supportive]] measures may also be required.<ref name=Ric2017/> Complications may include [[short-gut syndrome]], [[intestinal stricture]]s, or [[Developmental disability|developmental delay]].<ref name=Ric2017/>

<!-- Epidemiology -->
About 7% of those who are born prematurely develop NEC; however the odds of an infant developing this illness is directly related to the [[intensive care unit]] they are placed in.<ref name=":0" /><ref name="Ric2017" /><ref>Gephart  SM,  Spitzer  AR,  Effken  JA,  Dodd  E,  Halpern  M,  McGrath  JM.  Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis.

J Perinatol. 2014;34(6):468-475.</ref><ref>Horbar JD, Edwards EM, Greenberg LT, et al.  Variation in performance of neona-tal intensive care units in the United States. JAMA Pediatr. 2017;171(3):e164396.</ref><ref>Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical corre-lates.  National  Institute  of  Child  Health  and  Human  Development  Neonatal  Research Network. J Pediatr. 1991;119(4):630-638.</ref> Onset is typically in the first four weeks of life.<ref name=Ric2017/> Among those affected, about 25% die.<ref name=Mer2017/> The sexes are affected with equal frequency.<ref name=Pan2006>{{cite journal | vauthors = Panigrahi P | title = Necrotizing enterocolitis: a practical guide to its prevention and management | journal = Paediatric Drugs | volume = 8 | issue = 3 | pages = 151–165 | year = 2006 | pmid = 16774295 | doi = 10.2165/00148581-200608030-00002 | s2cid = 29437889 }}</ref> The condition was first described between 1888 and 1891.<ref name=Pan2006/>

==Signs and symptoms==
The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth (i.e., the earlier a baby is born, the later signs of NEC are typically seen).<ref>{{cite journal | vauthors = Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK | title = Incidence and timing of presentation of necrotizing enterocolitis in preterm infants | journal = Pediatrics | volume = 129 | issue = 2 | pages = e298–e304 | date = February 2012 | pmid = 22271701 | doi = 10.1542/peds.2011-2022 | s2cid = 26079047 | author7 = Canadian Neonatal Network }}</ref>

Initial symptoms include feeding intolerance and [[failure to thrive]], increased gastric residuals, [[abdominal distension]], and [[haematochezia|bloody stools]]. Symptoms may progress rapidly to abdominal discoloration with [[intestinal perforation]] and [[peritonitis]] and systemic [[hypotension]] requiring [[NICU|intensive medical support]].<ref>{{cite web |url= https://www.lecturio.com/concepts/necrotizing-enterocolitis/| title= Necrotizing Enterocolitis
|website=The Lecturio Medical Concept Library |access-date= 11 August 2021}}</ref>

==Cause==
The exact cause is unclear.<ref name=Mer2017/> Several risk factors have been implicated:<ref>{{cite journal | vauthors = Alganabi M, Lee C, Bindi E, Li B, Pierro A | title = Recent advances in understanding necrotizing enterocolitis | journal = F1000Research | volume = 8 | page = 107 | date = 2019 | pmid = 30740215 | pmc = 6348433 | doi = 10.12688/f1000research.17228.1 | doi-access = free }}</ref>

===Main risk factors===
* Low birth weight
* Prematurity
* Formula feeding (bovine based)
* [[Dysbiosis|Intestinal dysbiosis]]

===Other risk factors===
* Acute hypoxia
* Antibiotic exposure
* Blood transfusions
* Cardiac anomalies
* Neonatal anemia
* Poor intestinal perfusion
* Prolonged use of [[indomethacin]] for patent  ductus arteriosus closure

===Maternal factors===
* Acid-suppressing medications
* [[Chorioamnionitis]]
* Cocaine abuse
* ''In utero'' growth restriction
* Increased body mass index
* Intrahepatic cholestasis during pregnancy
* Lack of prenatal steroids
* Mode of delivery
* [[Placental abruption]]
* Pre-eclampsia
* Smoking

==Diagnosis==
[[File:Necrotizing enterocolitis 202.jpg|thumb|[[Radiograph]] of a baby with necrotizing enterocolitis]]
Diagnosis is usually suspected clinically, but often requires the aid of diagnostic imaging, most commonly [[radiography]], which can show the intestines and may show areas with dead tissue or a bowel perforation.<ref name="Cline_2021">{{Cite web | vauthors = Cline M |date=2021-07-14 |title=Necrotizing Enterocolitis: A Guide for Preemie Parents |url=https://www.birthinjuryguide.org/2021/07/necrotizing-enterocolitis-guide-parents/ |access-date=2021-08-19 |website=Birth Injury Guide |language=en-US}}</ref> Specific radiographic signs of NEC are associated with specific Bell's stages of the disease:<ref name="pmid17027734">{{cite journal | vauthors = Lin PW, Stoll BJ | title = Necrotising enterocolitis | journal = Lancet | volume = 368 | issue = 9543 | pages = 1271–83 | date = October 2006 | pmid = 17027734 | doi = 10.1016/S0140-6736(06)69525-1 | s2cid = 37235496 }}</ref>
* '''Bell's stage 1 (suspected disease)''':
** Mild systemic disease ([[apnea]], lethargy,<ref>{{cite journal | vauthors = Schanler RJ, Abrams SA, Kim MS | date = 2016 | title = Clinical features and diagnosis of necrotizing enterocolitis in newborns | journal = UpToDate | url = https://www.uptodate.com/contents/neonatal-necrotizing-enterocolitis-clinical-features-and-diagnosis }}</ref> [[bradycardia|slowed heart rate]], temperature instability)
** Mild intestinal signs (abdominal distention, increased gastric residuals, bloody stools)
** Nonspecific or normal radiological signs
* '''Bell's stage 2 (definite disease)''':
** Mild to moderate systemic signs
** Additional intestinal signs (absent bowel sounds, abdominal tenderness)
** Specific radiologic signs ([[pneumatosis intestinalis]] or [[Portal vein#Portal venous gas|portal venous gas]])
** Laboratory changes ([[metabolic acidosis]], [[thrombocytopenia|too few platelets]] in the bloodstream)
* '''Bell's stage 3 (advanced disease)''':
** Severe systemic illness ([[hypotension|low blood pressure]])
** Additional intestinal signs (striking abdominal distention, peritonitis)
** Severe radiologic signs ([[pneumoperitoneum]])
** Additional laboratory changes (metabolic and respiratory acidosis, [[disseminated intravascular coagulation]])

[[Ultrasonography]] has proven to be useful, as it may detect signs and complications of NEC before they are evident on radiographs, specifically in cases that involve a paucity of bowel gas, a gasless abdomen, or a sentinel loop.<ref name="Muchantef">Muchantef K, Epelman M, Darge K, Kirpalani H, Laje P, Anupindi SA. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 2013 Jun 15.</ref> Diagnosis is ultimately made in 5–10% of very-low-birth-weight infants (<1,500g).<ref>{{cite book | vauthors = Marino BS, Fine KS |title=Blueprints Pediatrics |url=https://books.google.com/books?id=oqpSRIOcd8MC |date=1 December 2008 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-8251-7}}</ref>

<gallery>
Image:Neonatal necrotizing enterocolitis, gross pathology 20G0022 lores.jpg|Esophagus, stomach and intestines of affected infant showing intestinal necrosis, pneumatosis intestinalis, and intestinal perforation (arrow) (autopsy specimen)

Image:Neonatal necrotizing enterocolitis, gross pathology 20G0023 lores.jpg|Close-up of intestine showing extensive necrosis (autopsy specimen)

</gallery>

Diagnosis of NEC is more challenging in premature infants, due to inexplicit symptoms and radiographic signs. The most preterm infant is at highest risk of developing NEC.<ref>{{cite journal | vauthors = Palleri E, Aghamn I, Bexelius TS, Bartocci M, Wester T | title = The effect of gestational age on clinical and radiological presentation of necrotizing enterocolitis | journal = Journal of Pediatric Surgery | volume = 53 | issue = 9 | pages = 1660–1664 | date = September 2018 | pmid = 29079313 | doi = 10.1016/j.jpedsurg.2017.09.018 | s2cid = 38176277 }}</ref>

==Prevention==
Prevention includes the use of breast milk and probiotics.<ref name=Ric2017/> A 2012 policy by the [[American Academy of Pediatrics]] recommended feeding preterm infants [[Breastfeeding|human milk]], finding "significant short- and long-term beneficial effects," including reducing the rate of NEC by a factor of one-half to three-quarters.<ref>{{cite journal | vauthors = ((American Academy of Pediatrics, Section on Breastfeeding)) | title = Breastfeeding and the use of human milk | journal = Pediatrics | volume = 129 | issue = 3 | pages = e827–e841 | date = March 2012 | pmid = 22371471 | doi = 10.1542/peds.2011-3552 | quote = Meta-analyses of four randomized clinical trials performed over the period 1983 to 2005 support the conclusion that feeding preterm infants human milk is associated with a significant reduction (58%) in the incidence of NEC. A more recent study of preterm infants fed an exclusive human milk diet compared with those fed human milk supplemented with cow's milk-based infant formula products noted a 77% reduction in NEC. | doi-access = free }}</ref>

Small amounts of oral feeds of human milk starting as soon as possible, while the infant is being primarily fed intravenously, primes the immature gut to mature and become ready to receive greater intake by mouth.<ref>{{cite journal | vauthors = Ziegler EE, Carlson SJ | title = Early nutrition of very low birth weight infants | journal = The Journal of Maternal-Fetal & Neonatal Medicine | volume = 22 | issue = 3 | pages = 191–197 | date = March 2009 | pmid = 19330702 | doi = 10.1080/14767050802630169 | s2cid = 36737314 }}</ref> Human milk from a [[milk bank]] or donor can be used if mother's milk is unavailable. The gut mucosal cells do not get enough nourishment from arterial blood supply to stay healthy, especially in very premature infants, where the blood supply is limited due to immature development of the capillaries, so nutrients from the lumen of the gut are needed.{{citation needed|date=August 2020}}

Towards understanding intervention with human milk, experts have noted cow's and human milk differ in their immunoglobular and glycan compositions.<ref>{{cite journal | vauthors = Bode L | title = Human milk oligosaccharides: every baby needs a sugar mama | journal = Glycobiology | volume = 22 | issue = 9 | pages = 1147–1162 | date = September 2012 | pmid = 22513036 | pmc = 3406618 | doi = 10.1093/glycob/cws074 }}</ref><ref>{{cite journal | vauthors = Boix-Amorós A, Collado MC, Van't Land B, Calvert A, Le Doare K, Garssen J, Hanna H, Khaleva E, Peroni DG, Geddes DT, Kozyrskyj AL, Warner JO, Munblit D | display-authors = 6 | title = Reviewing the evidence on breast milk composition and immunological outcomes | journal = Nutrition Reviews | volume = 77 | issue = 8 | pages = 541–556 | date = May 2019 | pmid = 31111150 | doi = 10.1093/nutrit/nuz019 | hdl = 10261/203022 | hdl-access = free }}</ref> Due to their relative ease of production, human milk oligosaccharides (HMO) are a subject of particular interest in supplementation and intervention.<ref>{{cite journal | vauthors = Bode L, Contractor N, Barile D, Pohl N, Prudden AR, Boons GJ, Jin YS, Jennewein S | display-authors = 6 | title = Overcoming the limited availability of human milk oligosaccharides: challenges and opportunities for research and application | journal = Nutrition Reviews | volume = 74 | issue = 10 | pages = 635–644 | date = October 2016 | pmid = 27634978 | pmc = 6281035 | doi = 10.1093/nutrit/nuw025 }}</ref>

A [[Cochrane Library|Cochrane]] review in 2020 (updated in 2023) found low- to moderate-quality evidence that supplementation of probiotics enterally "prevents severe NEC, as well as all-cause mortality in preterm infants" but cautioned that the evidence was not sufficient to inform policy and practice and that further high-quality trials are needed.<ref>{{cite journal | vauthors = Sharif S, Meader N, Oddie SJ, Rojas-Reyes MX, McGuire W | title = Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 7 | pages = CD005496 | date = July 2023 | pmid = 37493095 | pmc = 10370900 | doi = 10.1002/14651858.CD005496.pub6 }}</ref>

Advancing [[Enteral feeding|enteral feed]] volumes at lower rates does not appear to reduce the risk of NEC or death in very preterm infants and seems to increase the risk of invasive infection.<ref>{{cite journal | vauthors = Oddie SJ, Young L, McGuire W | title = Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 8 | pages = CD001241 | date = August 2021 | pmid = 34427330 | pmc = 8407506 | doi = 10.1002/14651858.CD001241.pub8 }}</ref>  Not beginning feeding an infant by mouth for more than 4 days does not appear to have protective benefits.<ref>{{cite journal | vauthors = Young L, Oddie SJ, McGuire W | title = Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD001970 | date = January 2022 | pmid = 35049036 | pmc = 8771918 | doi = 10.1002/14651858.CD001970.pub6 }}</ref>

==Treatment==
If a baby is diagnosed with NEC, treatment should begin immediately.<ref name="Cline_2021" /> Treatment consists primarily of supportive care, including providing bowel rest by stopping enteral feeds, gastric decompression with intermittent suction, fluid repletion to correct electrolyte abnormalities and [[Fluid compartments#Third space|third-space]] losses, support for blood pressure, [[parenteral nutrition]],<ref name="Heird">{{cite journal | vauthors = Heird WC, Gomez MR | title = Total parenteral nutrition in necrotizing enterocolitis | journal = Clinics in Perinatology | volume = 21 | issue = 2 | pages = 389–409 | date = June 1994 | pmid = 8070233 | doi = 10.1016/s0095-5108(18)30352-x }}</ref> and prompt antibiotic therapy.

Monitoring is clinical, although serial supine and left lateral decubitus abdominal X-rays should be performed every six hours.<ref>{{cite journal | vauthors = Neu J, Walker WA | title = Necrotizing enterocolitis | journal = The New England Journal of Medicine | volume = 364 | issue = 3 | pages = 255–264 | date = January 2011 | pmid = 21247316 | pmc = 3628622 | doi = 10.1056/NEJMra1005408 }}</ref>

As an infant recovers from NEC, feeds are gradually introduced. "Trophic feeds" or low-volume feeds (<20 ml/kg/day) are usually initiated first. How and what to feed are determined by the extent of [[bowel]] involved, the need for surgical intervention, and the infant's clinical appearance.<ref name="Christian_2018">{{cite journal | vauthors = Christian VJ, Polzin E, Welak S | title = Nutrition Management of Necrotizing Enterocolitis | journal = Nutrition in Clinical Practice | volume = 33 | issue = 4 | pages = 476–482 | date = August 2018 | pmid = 29940075 | doi = 10.1002/ncp.10115 | s2cid = 49419886 }}</ref>

Where the disease is not halted through medical treatment alone, or when the [[bowel perforation|bowel perforates]], immediate emergency surgery to resect the dead bowel is generally required, although abdominal drains may be placed in very unstable infants as a temporizing measure. Surgery may require a [[colostomy]], which may be able to be reversed at a later time. Some children may develop [[short bowel syndrome]] if extensive portions of the bowel must be removed.{{citation needed|date=August 2020}}

In the case of an infant whose bowel is left in discontinuity, the surgical creation of a mucous [[fistula]] or connection to the distal bowel may be helpful, as this allows for refeeding of [[ostomy]] output to the distal bowel. This refeeding process is believed to improve bowel adaptation and aid in advancement of feeds.<ref name="Christian_2018" />

==Prognosis==
Typical recovery from NEC if medical, nonsurgical treatment succeeds, includes 10–14 days or more without oral intake, and then demonstrated ability to resume feedings and gain weight. Recovery from NEC alone may be compromised by co-morbid conditions that frequently accompany [[Preterm birth|prematurity]]. Long-term complications of medical NEC include bowel obstruction and anemia.{{citation needed|date=August 2020}}

In the United States, NEC caused 355 deaths per 100,000 live births in 2013, down from 484 per 100,000 live births in 2009. Rates of death were almost three times higher for the black population than for the white population.<ref>{{cite journal | vauthors = Xu J, Murphy SL, Kochanek KD, Bastian BA | title = Deaths: Final Data for 2013 | journal = National Vital Statistics Reports | volume = 64 | issue = 2 | pages = 1–119 | date = February 2016 | pmid = 26905861 | url = https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf }}</ref>

When NEC is diagnosed and treated immediately, the prognosis for babies is generally very good. Most babies recover fully without any additional health problems.<ref name="Cline_2021" /> Overall, about 70-80% of infants who develop NEC survive.<ref name="Schanler, R.J. 2017">{{cite report | vauthors = Schanler RJ, Abrams SA, Kim MS | title = Management of necrotizing enterocolitis in newborns | work = UpToDate | url = }}</ref>  Medical management of NEC shows an increased chance of survival compared to surgical management.<ref name="Schanler, R.J. 2017"/>  Despite a significant mortality risk, long-term prognosis for infants undergoing NEC surgery is improving, with survival rates of 70–80%. However, "Surgical NEC" survivors are still at risk for possible long-term complications, such as narrowing of the intestines<ref name="Cline_2021" /> or [[Short bowel syndrome]] and [[Neurodevelopmental disorder|neurodevelopmental disability]].

== Society and advocacy ==
{{No sources section|date=September 2024}}
The [https://necsociety.org/ NEC Society] is a 501(c)(3), non-profit organization dedicated to building a world without necrotizing enterocolitis (NEC) through research, advocacy, and education. The NEC Society was launched in January 2014 by Jennifer Canvasser after her son, Micah, died from complications of NEC just before his first birthday. The NEC Society is a patient-led organization that collaborates with expert clinicians and researchers to better understand, prevent, and treat this devastating neonatal intestinal disease. Today, patient-families and experts from around the world work together to improve outcomes for the most vulnerable infants at risk of NEC. Their work and numerous initiatives combine the patient-family perspective with solutions based on the best available scientific evidence.

=== NEC Symposium ===
The  NEC Society hosts an in-person, biennial Symposium where clinicians, scientists and patient-families come together to listen, learn and collaborate. It is held as an "[https://necsociety.org/?s=all+in+meeting All-In Meeting]", where all stakeholders are fully integrated and empowered. Patient-families are central to the planning, preparation, and execution of the meeting. Each session is dedicated to a baby affected by NEC. Patient-families take part in each session as faculty and also present posters.

== References ==
{{Reflist}}

== External links ==
{{Medical resources
| DiseasesDB      = 31774
| ICD10           = {{ICD10|P|77||p|75}}
| ICD9            = {{ICD9|777.5}}
| ICDO            =
| OMIM            =
| MedlinePlus     = 001148
| eMedicineSubj   = ped
| eMedicineTopic  = 2981
| eMedicine_mult  = {{eMedicine2|radio|469}}
| MeshID          = D020345
| ICD10CM         = {{ICD10CM|K55.3}}
| Orphanet        = 391673
}}

{{Certain conditions originating in the perinatal period}}
{{Digestive system diseases}}

[[Category:Neonatology]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Wikipedia medicine articles ready to translate]]