Gastrointestinal outcomes in preemies

Preterm infants are at risk for gastrointestinal difficulties; problems with the stomach and intestines (bowels).

This article discusses the conditions, risks and other related outcomes that lead to or are affected by gastrointestinal difficulties in preemies.

gastrointestinal problems in preemie babies, nectrotising enterocolitis NEC

Necrotising enterocolitis

Preterm infants are at risk for gastrointestinal difficulties; problems with the stomach and intestines (bowels). Necrotising enterocolitis (NEC) is the most common emergency of these difficulties occurring in some premature babies. NEC is where portions of the bowel undergo necrosis, which means tissue death.

NEC occurs after birth and involves inflammation and infection of the small or large intestines and bacterial invasion of the bowel wall, which causes destruction of the bowel. As with most other organs of a preemie baby the bowel is not fully developed and is sensitive to changes in blood flow and is vulnerable to infection. Over 90% of infants who develop NEC are born preterm.

(Anand, Leaphart, Mollen, & Hackam, 2007; Lin & Stoll, 2006; Patole, 2007; Thompson & Bizzarro, 2008)

What are the Risk Factors for NEC?

The risk of NEC is inversely related to birth weight and gestational age, this means that the earlier or smaller a premature baby is born the higher the risk. In other words extremely preterm infants are at the highest risk. Preterm infants’ intestinal lining is fragile, and stresses such as infections and insufficient oxygen or blood flow can injure the bowel and can progress through the wall of the intestines. This in turn can cause tearing of the bowel and intestine resulting in spilling of the intestinal contents into the abdomen, which can cause other serious problems (peritonitis – infection of the abdominal cavity and sepsis). Although many researchers have tried to find the cause or causes of NEC it often remains difficult for medical providers to determine. It is important to note however that the cause/s of NEC is strongly related to the infants not receiving human breast milk from the baby’s own mother.

(Thompson & Bizzarro, 2008)

NEC is related to other health outcomes

Necrotising enterocolitis can lead to chronic conditions such as short-gut syndrome. NEC in extreme cases can lead to multisystem organ failure and death. NEC is the leading cause of death from gastrointestinal disease in preterm infants.

(Anand, et al., 2007)


Preterm infants who weigh less than 1000 g (2 ¼ pounds) at birth have the highest rates at up to 50% and the incidence for very low birth weight infants (less than 1500grams or 3 1/3 pounds) is between 5-10%. The rate drops dramatically for babies who weigh between 1501-2500 g at birth and/or born after 35-36 gestational weeks to less than 1% (3.8 per 1000 live births).

  • Extremely preterm/extremely low birth weight: up to 50% incidence
  • Very preterm/very low birth weight: 5-10% incidence
  • Preterm/low birth weight: less than 1%
(Duro et al., 2010; Group, 2010)

When does NEC develop?

Average age at onset in premature infants seems to be related to postmenstrual age, with babies born earlier developing NEC at a later chronologic age. The average age of onset has been reported to be 20.2 days for babies born at less than 30 weeks' estimated gestational age, 13.8 days for babies born at 31-33 weeks' EGA, and 5.4 days for babies born after 34 weeks' gestation.

(Anand, et al., 2007)

Related topics

Nutrition:Feeding by a tube in the NICU


Technical Reference List

Anand, R. J., Leaphart, C. L., Mollen, K. P., & Hackam, D. J. (2007). The role of the intestinal barrier in the pathogenesis of necrotizing enterocolitis. Shock, 27(2), 124-133.
Furzan, J. A., Reisch, J., Tyson, J. E., Laird, P., & Rosenfeld, C. R. (1985). Incidence and risk factors for symptomatic patent ductus arteriosus among inborn very-low-birth-weight infants. Early Hum Dev, 12(1), 39-48.
Duro, D., Kalish, L. A., Johnston, P., Jaksic, T., McCarthy, M., Martin, C., et al. (2010). Risk Factors for Intestinal Failure in Infants with Necrotizing Enterocolitis: A Glaser Pediatric Research Network Study. Journal of Pediatrics, 157(2), 203-U250
Group, E. (2010). Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr, 99(7), 978-992.
Lin, P. W., & Stoll, B. J. (2006). Necrotising enterocolitis. Lancet, 368(9543), 1271-1283.
Patole, S. (2007). Prevention and treatment of necrotising enterocolitis in preterm neonates. Early Hum Dev, 83(10), 635-642.
Thompson, A. M., & Bizzarro, M. J. (2008). Necrotizing enterocolitis in newborns : pathogenesis, prevention and management. Drugs, 68(9), 1227-1238.
Zaichkin, J. (2009). Newborn Intensive Care: what every parent needs to know (3rd ed.). MI: Sheridan Books.



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