Necrotizing Enterocolitis (NEC) Treatment Options

In light of recent product recall by Simply Thick, LLC concerning some of their SimplyThick thickening gel brands, because of a likely connection to the life-threatening disease necrotizing enterocolitis (NEC), it is important for those with affected infants to know the potential treatment options.

The general course of treatment action for infants suffering from NEC is decided by whether or not the child requires surgery for the disorder. This determination is made by finding out whether or not the baby’s intestine has been perforated (has developed holes).

If there is no sign of perforation in the child’s intestine, surgery may not be required. The procedure for treating infants with NEC without surgery involves a series of steps designed to heal the child and monitor his or her improvement throughout the process.

Key elements of the non-surgical treatment process for NEC:

- A nasogastric (NG) tube, which runs from the baby’s nose to the stomach. The NG tube removes air out of the stomach and intestines. The child generally keeps the NG tube until all signs suggest that their intestines are fully healed and ready to handle a formula-based diet.

- Intravenous (IV) fluids to prevent dehydration, to keep the infant’s blood chemicals stable and normal, and to provide them with nutrients. Additionally, the child receives IV antibiotics to fight infection. Generally, babies with NEC on given antibiotics for about two weeks. During this time, babies are not fed in order to allow their bowel to rest and heal, which makes the use of IV nutrition a necessity. IV fluids also help to keep a baby’s blood pressure normal to ensure that the intestines receive a good amount of blood flow. In some cases the child will also be prescribed blood pressure medication to support the process.

- During the treatment process, doctors utilize blood tests and X-rays to monitor the baby’s health and overall progression.

For mild cases of NEC, the above steps are generally what your child’s doctor will prescribe. In more severe cases, however, it is quite possible that the baby may need surgery in order to removed part of the damaged intestine. The objective of surgery for NEC is to remove the dead or perforated segment of intestine, while leaving as much as possible of the intestine. The child has a higher likelihood of a healthy development if they have more intestine left. In some cases where parts of the intestine are left in the child in an inflamed or infected state, those sections of the organ may heal properly over time.

Key elements of the surgical treatment process for NEC:

- Prior to the surgery, the surgeon and the neonatologist, a doctor specializing in newborn infants, will try to make the baby’s condition stable. The child will need the same treatments as infants who do not need to have surgery, including an NG tube and IV fluids and antibiotics.

- The surgical procedure, which requires general anesthesia for the baby, involves an incision just above the belly button to allow access to the child’s abdomen. Once inside, the surgeon removes the segments of the bowel that are dead.

- Because it is preferable to leave as much as the child’s intestine intact as possible, surgeons may opt to leave sick, but not dead, parts of the intestine in the child. Should the sick parts remain a problem, the child may have another operation within one to two days of the original procedure.

- If a small segment of the intestine was taken out, the surgeon will sometimes sew the two open ends of the intestine together after the removal. This procedure, known as primary anastomosis, is usually only feasible if the rest of the intestine is healthy and the infant is in good condition.

- If a large segment of the intestine was removed or the remaining intestines do not seem healthy, the surgeon may opt to not connect the two open ends. Instead, he or she will create two small openings, known as stoma, in the child’s belly through a procedure called an ostomy. The surgeon attaches the upper portion of the intestine to one of the openings. This allow for bowel movements to exit the body into a plastic pouch attached on the outside. The surgeon then attaches the lower portion of the intestine to the remaining opening, which is known as the mucus fistula. In the case that the child needs ostomies, the surgeon will eventually connect the two ends of the intestine and close the openings in your baby’s belly when the baby is doing better. This usually happens two or more months after surgery when the baby is growing and healthy. Babies who have a large segment of intestine removed may also be at risk for short bowel syndrome. This prospect is another reason for the surgeon to try and keep as much of the child’s intestine intact as possible.

- Strictures, scars that make the intestine very narrow, may start to form as NEC heals. This occurs most often at the location where the surgeon sewed the two ends of the intestine together or in parts of the intestine that had NEC but did not need surgical treatment. If a stricture forms, the baby generally needs additional surgery to fix it.

- After surgery, infants go into a neonatal intensive care unit (NICU) that provides necessary level of care. After the NICU stay is complete, the child moves to a standard hospital setting before they are allowed to go home.
Generally babies with NEC need to stay in the hospital for several weeks, regardless of whether or not they had surgery. Long hospital stays for infants with NEC are also affected by the fact that the child was more than likely born prematurely and must deal with other complications.

At Shrader & Associates, L.L.P., we are aware that hiring an attorney is often a difficult process for the inexperienced. Our team of dedicated and professional legal experts will take the time to understand your unique circumstances and help guide you through the difficult road ahead. You and your family come first, and we will do everything possible to help make sure you get the best possible outcome you deserve.

Please do not hesitate to contact Shrader & Associates, L.L.P. for more information

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