Introduction

What is NEC?

NEC is a disease affecting premature babies' intestines, often involving inflammation and damage to the intestinal tissue. As NEC advances, it can cause a hole in the intestine, leading to leakage of the intestinal waste into the baby’s belly and the bloodstream, causing infection and death.¹

Who is at risk of developing NECs?

• Premature childbirth before the 36th week of pregnancy
• Babies weighing less than 1500 gms²
• Formula feeding

What causes NEC?

Even though the exact cause of NEC is unknown, it is believed to have multiple contributing triggers, which includce:

1. Premature babies have weaker immune systems, which increases their chances of acquiring infections
2. Infants given formula milk develop NEC as they cannot properly break down food due to an underdeveloped digestive system, allowing harmful bacteria to grow, resulting in infection and inflammation³
3. Intestinal tissue damage occurs due to low blood flow to the gut, resulting in a lack of oxygen, which helps the bacteria enter the bloodstream, leading to infection and death⁴
4. The combination of delivery via c-section, excessive prolonged use of antibiotics and lack of feeding breast milk has also contributed to the development of NEC⁵

What are the symptoms of NEC in infants?

NEC usually occurs around two to six weeks post-birth. The symptoms include:

• Poor feeding
• Unable to digest food
• Stomach pain and bloating
• Diarrhoea with bloody stools
• Greenish vomit
• Unstable temperature
• Low blood pressure and heart rate
• Temporary stoppage of breathing⁶

How can we prevent NEC?

• Steroid injections can be given to a mother who is at risk for premature delivery. This medication can help the developing fetus lower the incidence of lung(respiratory distress syndrome) and gut diseases(NEC). As well as reduce the chances of intracranial haemorrhage (bleeding inside the head; between the brain and skull) and death⁷
• Feeding a baby their mother's milk can also help lower the risk of NEC

How does breast milk protect against NEC?

Mom’s milk is “Liquid Gold”, and soon after childbirth, the initial 2-3 days, the breasts produce a special milk known as the colostrum, which is yellowish in colour. This nutrient-rich milk is easier to digest, protects the baby from illness with infection-fighting white blood cells and disease-fighting antibodies. Breast milk supports the development of the baby’s stomach and intestines and assists the maturing of the immune system, which no formula milk can provide. Commercial infant milk usually comprises cow milk or soy products that are industrially modified and lack disease-fighting antibodies.⁸

Mother's milk offers absolute protection against NEC as it contains components such as:

1. Human Milk Oligosaccharides (HMOs) act as prebiotics, supporting a healthy and balanced gut by enhancing the growth of good bacteria and inhibiting harmful ones. HMOs also have an antibacterial effect, killing harmful bacteria directly or reducing their multiplication, thus enhancing immune function and reducing the risk of NEC in premature babies⁹
2. Immunoglobulins(e.g., IgA) are antibodies that help protect the baby from infections by enhancing the immune system's strength
3. Lactoferrin, a colostrum nutrient, helps boost the immune defence, reduces inflammation and stimulates intestinal tissue growth⁵
4. Epidermal growth factor(EGF) is a protein that helps restore, multiply, and mature intestinal cells within the baby’s gut

Reproduced from: Bode L. Human milk oligosaccharides in the prevention of necrotising enterocolitis: a journey from in vitro and in vivo models to mother–infant cohort studies. Front Pediatr. 2018;6:385. Available from: https://doi.org/10.3389/fped.2018.00385

FAQ's

How common is NEC?

The occurrence varies between 0.3 and 2.4 infants per 1000 live births worldwide.

What if mom's milk is unavailable?

The safest alternative is to provide pasteurised donor milk to the infant with NEC, in the absence of the mother's milk.

Summary

NEC is a disease of the bowel mainly affecting premature babies. It involves inflammation, killing the intestinal tissues, leading to intestinal wall perforation and death. Common risk factors are premature birth, formula feeding, and antibiotic exposure. The exact cause of NEC is unknown, but we know it is usually linked to low immunity, harmful bacterial overgrowth and low oxygenated blood flow to the gut. Doctors encourage feeding the infant with breast milk as it gives immunity, reduces swelling, and helps maintain a healthy gut, thereby preventing the incidence of NEC.