Necrotizing enterocolitis (NEC) is a serious gastrointestinal problem that mostly affects premature babies and that inflames and destroys intestinal tissue, causing necrosis. Severe NEC can cause a hole to form in a baby’s large or small intestine. Bacteria can leak through the hole into the abdomen or bloodstream, causing a potentially fatal infection and other complications.
The NEC Society reports that thousands of babies in the United States develop NEC every year and that hundreds of those babies die. The intestinal disease has about a 30% mortality rate. NEC affects between 1 in 2000 and 1 in 4000 births and equates to between 1%-5% of neonatal intensive care unit (NICU) admissions. It occurs in nearly 10% of premature infants.
NEC Mostly Affects Premature Babies
About 90% of all babies who are diagnosed with NEC were born prematurely. Specifically, NEC usually affects babies born before the 37th week of pregnancy, babies who are fed through a tube in the stomach (enteral nutrition), and babies weighing less than 5.5 pounds at birth. The condition usually develops within 2-6 weeks after birth, so it is important to identify symptoms early and seek the assistance of a pediatrician.
Types of NEC
There are several types of NEC and varying levels of severity. Class NEC is the most common type of NEC, which usually affects infants born before 28 weeks of pregnancy, and the condition develops 3-6 weeks after birth. The condition usually comes on suddenly and without any warning symptoms.
Transfusion-associated NEC can occur if an infant needs a blood transfusion to treat a lack of red blood cells (anemia). About ⅓ of premature babies develop NEC within three days of receiving a blood transfusion.
It’s rare for infants to develop NEC in their first week of life or before their first feeding. It’s also very rare for full-term babies to get NEC.
NEC symptoms usually begin 2-6 weeks after birth. The symptoms may come on gradually over a few days or appear suddenly.
- Abdominal pain and swelling
- Changes in heart rate, blood pressure, body temperature, and breathing
- Diarrhea with bloody stool
- Green or yellow vomit
- Refusal to eat or lack of weight gain
NEC complications can have catastrophic ramifications, especially if it goes untreated or undiagnosed for too long.
Complications of NEC can include the following and more:
- Holes in the intestinal wall
- Peritonitis and sepsis
- Intestinal stricture caused by scarring
- Short bowel (short gut) syndrome
- Growth failure
- Inability to absorb food and nutrients
Of note, narrowed and scarred intestines caused by NEC usually develop a few months after the infant recovers. The narrowed intestine makes it difficult for food to pass through, and surgery may be required to open the intestine.
Short bowel (short gut) syndrome can also occur if NEC destroys or damages part of the infant’s small intestine. The condition makes it hard for the body to absorb fluids and nutrients, resulting in malabsorption. Children with short bowel syndrome require lifelong care to get necessary nutrition, and some children may require tube (enteral) feedings.
Furthermore, growth failure, poor neurodevelopmental outcomes, and developmental delays can occur in infants who suffer from NEC – especially those who require surgery.
Potential Causes of NEC
Doctors are uncertain about the definitive cause of NEC. Extensive research has been conducted, but there is still more to do. But many potential causes point toward ingesting cow milk-based baby formula.
Potential causes of NEC include:
- Feeding premature infants formula instead of human breast milk.
- Underdeveloped (premature) intestine.
- Too little oxygen or blood flow to the intestine at birth or after.
- Injury to the intestinal lining.
- Bacteria growth in the intestine that erodes the intestinal wall.
- Viral or bacterial infection in intestines.
The American Academy of Pediatrics advised that all infants should receive fresh or frozen human milk as their primary diet for six months followed by a combination of breast milk and other foods for another year. If the infant’s mother’s milk is unavailable, pasteurized human donor milk should be used.
Why is Formula Feeding a Potential Cause of NEC?
Baby formula is often fed to premature babies or low birth weight infants in NICUs or hospitals before going home.
Baby formula, especially cow milk-based formula, is considered a potential cause of NEC. Human milk is easier to digest than other alternatives. It also contains substances that help fight infection and help intestinal cells mature. Premature infants who consume their own mother’s milk in the first days of their life are less likely to get infections, NEC, and other fatal complications.
Research Points to Cow Milk-Based Formula Dangers
Studies concluded that although maternal breast milk may contain fewer nutrients than artificial formula milk, maternal breast milk provides vital non-nutrient advantages for preterm or low-weight infants who are most likely to be impacted by NEC. Studies also found an increased risk of NEC associated with premature infants not being fed predominantly human milk. Babies fed cow milk fortifiers (formulas) were more than three times more likely to develop NEC.
Another study compared results of premature infants fed an exclusive human milk diet with premature infants fed human milk supplemented with cow milk-based infant formula products. The results showed the premature infants only fed human milk were 77% less likely to develop NEC. A European meta-analysis of four randomized clinical trials from 1983 to 2005 supports the conclusion that feeding premature infants human milk created a 58% reduction in infants developing NEC. Lastly, a study conducted by the American Society for Nutrition concluded that milk-based infant formulas led to a higher incidence of NEC in premature infants compared with human milk.
[Please see reference links below for more information about the studies mentioned in this section.]
Types of Cow Milk-Based Infant Formulas
Cow milk-based infant formulas Enfamil (manufactured by Mead Johnson Nutrition) and Similac (manufactured by Abbott Laboratories) are popular substitutes for human milk. However, these products are now implicated in lawsuits against the manufacturers for failing to warn about the increased risk of NEC. Neither Enfamil nor Similac has warning labels on their products to alert parents of the increased risk to their premature infants of developing NEC if they are fed cow milk-based formulas.
How GoldenbergLaw Can Help YouIf your premature infant developed NEC after consuming Enfamil or Similac, contact our team at GoldenbergLaw. Our team of Minnesota NEC Lawyers has the compassion, knowledge, and experience to help you get justice for the harm your newborn and family have suffered. We have provided clients the Gold Standard of advocacy for more than 35 years, so you can leave the sleepless nights working on a tough case to us.
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- “Necrotizing Enterocolitis [NEC]” (Cleveland Clinic)
- “What is NEC?” (NEC Society)
- “Necrotizing Enterocolitis” (Children’s Hospital Los Angeles®)
- “Necrotizing Enterocolitis” (Nemours KidsHealth®)
- “Breastfeeding and the Use of Human Milk” (American Academy of Pediatrics)
- “Necrotizing Enterocolitis in the Newborn” (Stanford Children’s Health)
- “Is Mother’s Own Milk Lactoferrin Intake Associated with Reduce Neonatal Sepsis, Necrotizing Enterocolitis, and Death?” (Neonatology 2020, journal)
- “Formula milk versus maternal breast milk for feeding preterm or low birth weight infants” (Cochrane Library)
- “Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants” (National Library of Medicine)
- “Human milk based fortifiers improve health outcomes for the smallest premature babies” (ScienceDaily®)
- “An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products” (The Journal of Pediatrics, ScienceDirect)
- “Breastfeeding and maternal and infant health outcomes in developed countries.” (Europe PMC)
- “Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products” (National Library of Medicine National Institutes of Health)