NEC is one of the most dreaded complications that a premature infant can develop. I hate it with a passion.
And you can do everything that you are supposed to do---monitor the infant closely, notify the doctor at the first sign of feeding intolerance, abdominal distention, guaiac positive stools, etc. And still lose that baby.
I cared for an infant once who was po feeding, room air, no pre-existing factors for sepsis, doing "well". Three hours into my shift, at 0200, he had his first guaiac + stool. I notified the on-call doctor, who came and examined him. He had no other symptoms, was still active, responsive, vital signs stable. Abdominal X Ray was negative. Doc said to continue to feed & monitor. Within 12 hours he had died from what his doctors described as "fulminating NEC". I was shocked. So many "what ifs". Should we have placed him NPO immediately? Should we have done blood work? Started serial abdominal films? Started antibiotics? Would it have made a difference? He went from being asymptomatic to being in full blown septic shock from NEC within a few hours.
Another patient in our NICU was an ex-preemie was in an open crib, po feeding, slated for discharge within a couple of days. The nursing staff went home that morning, only to return 16 hours later to find him with a severe case of NEC, with pneumatosis on X ray, followed by bowel perforation within another couple of hours. He too did not survive. How do you tell a parent that their son, who had battled months of complications related to prematurity, and overcome one obstacle after another, was not going to be going home? It breaks my heart.