Enterocolitis, Necrotizing

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Definition and Characteristics

Necrotizing enterocolitis (NEC), characterized by intestinal necrosis (Fig. 1), typically presents with abdominal distension, occult or fresh blood in stools, and bilious emesis [1].

Enterocolitis, Necrotizing. Figure 1

A neonate with necrotizing enterocolitis. Note the necrotic bowel found at laparotomy.

Non-specific clinical features include lethargy, poor feeding, temperature instability, apnea, respiratory distress, and bradycardia [1]. Other manifestations such as abdominal wall erythema, abdominal tenderness and guarding, shock, metabolic acidosis, and disseminated intravascular coagulopathy are seen in severe cases.


NEC most commonly presents in the first 2 weeks of life [1]. The incidence is estimated to be 3 per 1,000 live births and 50 to100 per 1,000 in very low birthweight infants (<1,500 g) [2]. The male to female ratio is approximately equal.

Molecular and Systemic Pathophysiology