Necrotizing Enterocolitis: Symptoms

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Symptoms

Often, a newborn baby is feeding well, healthy, and growing before there are any signs of necrotizing enterocolitis. Typically, a doctor or nurse will notice signs and symptoms of the disease 4 to 10 days after your newborn begins milk feeding. (Sometimes a premature newborn is first fed through a tube.) But symptoms may appear as soon as 4 hours or as late as 3 months after birth.

If your newborn has mild or moderate necrotizing enterocolitis, he or she may:

• Have a swollen, tender, red or shiny belly, with a firm loop of bowel in the intestines that your doctor can feel.
• Not want to eat, or may be throwing up (often greenish or greenish yellow vomit), which can lead to dehydration.
• Have a change in bowel movements. This includes:
  • Dark, black, or bloody stools.
  • Delayed passage of meconium in the first 24 to 48 hours after birth.
  • Fewer bowel movements than expected, or diarrhea.
• Be short of breath or stop breathing for longer than 10 seconds.
• Have a low or unstable body temperature.
• Not be very active, or may have little energy.
• Have few or no bowel sounds—the normal gurgling, rumbling, or growling noises in the stomach. If your baby does not have these noises, it can mean that his or her digestive system is not working well.

Less than half of the time, a newborn will have more serious symptoms that indicate severe necrotizing enterocolitis and may require surgery. These symptoms include:

• Infection in the belly area (peritonitis). Your baby may have a swollen, hard belly; severe belly pain and tenderness; nausea and vomiting; a fast heartbeat; chills and fever; and rapid breathing.
• Bleeding in the intestines.
• Tissue death (necrosis) in part of the intestines.
• Infection in the blood (sepsis).
• Difficulty clotting blood (disseminated intravascular coagulation, or DIC). DIC often damages every organ in the body.
• Heart or lung failure.
• Shock.

Necrotizing enterocolitis may be mistaken for other conditions with similar symptoms.

Last updated:	May 15, 2007
Author:	Debby Golonka, MPH
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Jennifer Merchant, MD - Neonatal-Perinatal Medicine
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC