This blog post is for the sake of information for not only myself but evidence based information for all those who are interested in what Necrotizing Enterocolitis (NEC) is or how it has become a hot topic. This is not a debate about whether or not formula as it is or the companies who push it are good or bad but about how it can possibly contribute to NEC and why the lawsuit is taking place. I am neutral as a birth worker and future mother when it comes to formulas’ place in newborn feeding but I will say that everyone who wishes to breastfeed should at least try and have the support if they wish to continue.
Necrotizing Enterocolitis occurs when the tissue in the large intestine of the newborn gets inflamed. This is a gastrointestinal emergency and can lead to morbidity/mortality of the infant. Its cause is still unknown although cases of NEC have been appearing over the last five decades. There have been theories as to why this occurs in some infants and not others as well as which infants are more at risk.
Symptoms of NEC include but are not limited to:
Slow heart rate
Apnea (breathing that cuts short or starts and stops)
Bloating or swelling of the belly
Bloody bowel movements
Greenish colored bile in the stomach
Distended bowels with gas
Abdominal ascites (build up of fluid in the belly)
NEC affects, more often than not, preterm infants meaning those born before 37 weeks gestation. Due to their preterm birth they are typically of lower birth weight and weaker gastrointestinal function which can increase the chance of NEC. Of the preterm infants born in one year, there are about 7% to 13% who will contract NEC and of those the mortality can be as high as 37%. Term infants, born 37 weeks to 42 weeks, can also contract NEC although the rate is lower at 10%. Full term infants are usually diagnosed sooner possibly due to them feeding earlier. There isn’t much research on how often term infants do not survive the condition but nearly half regardless of when they are born are going to require emergency surgery to try to correct it.
Due to there being a relationship between low birth weight and intestinal prematurity with NEC, there is also a connection to formula which is given to low birth weight and preterm infants in most hospital settings. Formula of all brands are meant to assist the infant in gaining weight and promoting neurological development as well as nutrition. Depending on the infant, a plan will be made of how much exact formula will be given to the infant and how much weight gain they should be displaying over time. Unfortunately, although their weight gain may be faster on formula than the birthing person’s milk or donor milk, the risk of NEC increases due to extra vitamins, minerals, etc. in the formula which underweight newborns sometimes cannot metabolize. In a 1990 study of 926 infants, Lucas and Cole found that formula-fed infants were 6 to 10 times more likely to develop NEC when compared with exclusively breastfed infants.Human milk is easier to digest than formula which is usually cow milk based and if the child cannot take cow milk then there are soy based formulas.
Treatment of NEC consists of preventative measures, for example stopping sepsis before it can occur, as well as surgery (laparotomy) to maintain stability. Broad spectrum antibacterial therapy as well as frequent abdominal examination and radiographs are measures taken to assess for intestinal perforation. Unfortunately even with surgery some infants will have NEC totalis which only leaves 25% of the bowel viable and raises the mortality rate to 80%. Those who require surgery have more significant long-term complications. Of those infants who survive NEC, intestinal strictures (bowel obstruction) occur in 10% to 35% independent of medical or surgical management.Up to 25% of infants requiring surgery for NEC suffer long-term complications such as short-bowel syndrome and problems related to dependence on total parenteral nutrition. Infants with NEC also suffer from increased risk for neurodevelopmental impairment, such as cerebral palsy, deafness, and blindness.
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