Necrotizing Enterocolitis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Necrotizing Enterocolitis?
A neonatologist, a doctor who cares for sick or premature newborns, usually leads care for necrotizing enterocolitis (NEC). A pediatric surgeon, a surgeon for children, may be needed if the bowel is damaged. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is necrotizing enterocolitis?
Necrotizing enterocolitis, or NEC, is the death of tissue in the intestine. It occurs most often in premature or sick babies. The tissue lining the intestine becomes inflamed (swollen and irritated), dies, and can slough off (come away).
NEC is the most common serious gastrointestinal disease in newborn infants. Healthcare providers consider it a medical and surgical emergency. It usually occurs before the newborn leaves the hospital. In preterm infants it usually begins within the first 2 or 3 weeks after birth.
Symptoms
Symptoms can develop over a period of days or appear suddenly. Commonly reported symptoms include:
- Poor tolerance of feeding, which means the baby cannot digest food.
- Bloating or swelling of the belly.
- Belly discoloration, usually bluish or reddish.
- Pain when someone touches the belly.
- Blood in the stools, or a change in how often the baby has stools.
- Diarrhea.
- Vomiting greenish-yellow liquid.
- Low energy, called lethargy.
- Trouble keeping a normal body temperature.
- Episodes of a low heart rate or apnea, a temporary stop in breathing.
In advanced cases, blood pressure may drop and the pulse may become weak. The baby may go into shock. The affected area of the intestine may also develop a hole, called a perforation, that needs emergency surgery.
Causes and who gets it
The exact cause of NEC is unknown. A drop in blood flow to the bowel can damage the tissue. Bacteria in the intestine may also add to the problem. Premature infants also have an undeveloped immune response, which is the body's defense system.
All babies born before 37 weeks of pregnancy, or with a low birth weight, are at higher risk. Low birth weight means less than 2,500 grams, or about 5.5 pounds. The smaller or more premature the baby, the greater the risk. Other babies at higher risk include:
- Infants fed formula rather than human milk.
- Infants in a nursery where an outbreak has occurred.
- Infants who have received blood exchange transfusions or have been seriously ill.
NEC occasionally occurs in babies born at full term. These babies often have another serious illness, such as congenital heart disease, which means a heart problem present from birth.
How doctors diagnose it
Symptoms such as trouble with feeding, bloody stools, or a swollen belly could point to NEC. The condition is usually confirmed by an abdominal X-ray. Doctors look for a bubbly look in the wall of the intestine or for air outside the intestine.
Other tests may include a stool test for hidden blood, a complete blood count (a test that counts the different cells in the blood), and other blood tests. These include checks of electrolytes, which are minerals in the blood, and blood gases. Blood tests can also check for infection.
Treatment
Treatment for a baby who may have NEC most often includes:
- Stopping feedings through the gut.
- Placing a tube in the stomach to relieve gas and remove air and fluid.
- Giving fluids and nutrition through a vein.
- Giving antibiotics through a vein.
- Watching the baby with belly X-rays and blood tests.
- Giving oxygen or putting the baby on a ventilator, a breathing machine, if a swollen belly makes it hard to breathe.
Many infants respond to treatment within 72 hours, and doctors may then restart regular feeding. The infant will need surgery if there is a hole in the intestines or inflammation of the abdominal wall, called peritonitis. In surgery, the surgeon removes dead bowel tissue. The bowel may be reconnected after several weeks or months when the infection has healed.
Short bowel syndrome can happen if a large amount of intestine is lost.
When to see a doctor
Call 911 or get emergency medical care if your baby has any symptoms of NEC, such as a swollen belly, blood in the stool, or vomiting greenish-yellow liquid.
Babies who are in the hospital for illness or prematurity are at higher risk. They are watched closely for this problem before they are sent home.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. After a baby goes home, they can help with follow-up visits and coordinate the specialists who care for the child.
Common questions
Is necrotizing enterocolitis life threatening?
Yes, NEC is a serious disease. Up to 40% of infants with NEC die from it. Early, aggressive treatment can help improve the outcome.
Who is at risk for NEC?
Babies born before 37 weeks of pregnancy or with a low birth weight are at higher risk. The smaller or more premature the baby, the greater the risk.
Can human milk help prevent NEC?
It may. Human milk contains growth factors, antibodies, and immune cells which may help prevent the problem. Babies fed formula rather than human milk are at higher risk.
Does a baby with NEC always need surgery?
No, not always. Many infants respond to treatment within 72 hours. Surgery is needed if there is a hole in the intestines or inflammation of the abdominal wall, called peritonitis.
Sources
- MedlinePlus - Necrotizing enterocolitis
- NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development - Necrotizing Enterocolitis (NEC)
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
