I just don't get NEC!!!

BittyBabyGrower, MSN, RN · Apr 27, 2006

Probably no connection between them and patient care. Most likely, they had some hypoxic event at some time that caused part of the bowel to die. There are lots of theories and speculations that surround NEC, but usually it is linked to hypoxia or drug use in the mom. Also, sometimes kids with genetic problems seem to be a little more prone also.

EricJRN, MSN, RN · Apr 27, 2006

There is some evidence that points to an infectious cause and clusters of cases are sometimes seen in the NICU, although no single organism has been implicated. Here are some links for more info:

http://www.emedicine.com/PED/topic2601.htm

http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm

http://www.pediatrie.be/NECROT_%20ENTEROCOL.htm

dawngloves, BSN, RN · Apr 27, 2006

I don't think they have a connection, but what gestation are these kiddos?

prmenrs, RN · Apr 27, 2006

You are not alone in not "getting" NEC. Some really smart Neonatologists don't get it either.

Lots of theories, not a one of 'em fits all cases. BUT, it would be a great research project. You wouldn't need to write it up if you didn't have to, but start collecting articles and other bits of info on the topic in a file (after you've read and highlighted them).

mom23RN · Apr 27, 2006

Uuuugh!!! I hate NEC. It strikes the little, the big, the healthy, the compromised. It isn't prejudiced....

My son died from NEC. He was a heart baby and was born full-term. They figured it was something that started to happen during his open heart when he was 5 days old. He died suddenly when he was 10 weeks old.

Such a horrible thing. I heard it's pretty common for babies who have had open heart though. Maybe something they'll start to keep an eye on a little closer.

llg, PhD, RN · Apr 27, 2006

I got my first NICU job in 1977 -- and left only a few years ago to work on hospital-wide projects. I used to teach NEC in orientation ... and have been through a major cluster of cases ... and have watched many babies get NEC.

As all the other posters have said, NEC is a disease of unknown etiology. There have been lots of theories posed over the years ... and lots of suggestions on how to decrease its incidence ... but none have proven to be the ONE answer for all babies. My personal opinion is that it is a syndrome that arises when conditions are right, but that those conditions can vary slightly from case to case.

The bowel lining is vulnerable because it is immature. Hypoxic episodes can cause local tissue damage as blood is shunted away from the gut to higher priority areas. Feeding asks the bowel to do work and causes further stress. There are microbes present in the bowel and a variety of bugs in the environment. Those microbes can "take hold" if there is even the smallest amount of tissue damage. The newborn is not very good at isolating and fighting infection. Thus, conditions are right for a little infection to become a severe one.

Watching a baby who was recovering and growing nicely suddenly get NEC and die can be one of the hardest things for NICU staff to cope with. A lot of people blame themselves and/or blame their co-workers. Wanting to find the culprit and prevent it from happening again is a natural and noble response. You are not alone. A lot of research has been done on it -- but no single factor has yet to be isolated. That's why I lean toward the multi-factorial explanations.

llg

LilPeanut, MSN, RN, NP · Apr 30, 2006

I'm going to nod to everyone above. I've heard of it clustering in areas in NICUs, to the point where Rainbow Babies in Cleveland puts NEC babies in iso because they noticed it. My NICU does not, because we've not had clusters like that.

I've heard of it being associated with artificial milk (and I would assume fortification as well) human milk is a natural antibiotic and some outbreaks of NEC have been traced back to formula. But not in every case.

The hypoxemia is another theory, which I also think has some merit. But there have been kids who've gotten NEC without that.

It think, unfortunately, it's just one of those things that has so many different causes with the same end result, that we'll never know for sure.

dawngloves, BSN, RN · May 1, 2006

Our hospital just started a NEC study.It'll take about 2 years, depending on how much poop they can get.

Jolie, BSN · May 1, 2006

Our hospital just started a NEC study.It'll take about 2 years, depending on how much poop they can get.

I can see the posters now: "Support neonatal research...POOP!":lol2:

prmenrs, RN · May 1, 2006

Our hospital just started a NEC study.It'll take about 2 years, depending on how much poop they can get.

:smackingf That's baaad!

dawngloves, BSN, RN · May 1, 2006

:smackingf That's baaad!

:roll Seriously.They are going to study the stool of 100 neonates from meconium to d/c. But it all depends on our census.Could be two years, could be a year if we are knee deep in it.