Posted: 26/06/2024
Necrotising enterocolitis (NEC) is a serious medical condition that primarily affects premature infants, particularly those born before 32 weeks of gestation. It is a condition characterised by damage to the intestines, which arises when the tissue in the intestines becomes inflamed and begins to die off. If NEC is caught early, the harm caused to the infant will be relatively minimal. However, if left untreated, the consequences of NEC can be life-threatening.
The true incidence of NEC among infants born in the UK is difficult to discern, as there is little consistency in diagnostic processes and statistical analysis when it comes to NEC. However, the most consistent finding in published reports of NEC is that, in very low birth weight infants (<1500g at birth), there is an incidence rate of around 10%.
The exact cause of NEC is not fully understood, but several risk factors have been identified. Premature babies are most susceptible to NEC because their intestines are not fully developed. Other contributing factors include a compromised immune system, a decreased blood supply to the intestines, and an overgrowth of harmful bacteria in the gut.
NEC can lead to a range of symptoms, including abdominal distension, blood in the stool, feeding difficulties, and a decrease in overall wellbeing. In severe cases, NEC can cause perforation of the bowel, leading to a life-threatening infection.
It can be difficult to diagnose NEC at an early stage, given its non-specific symptoms, which overlap with symptoms of other, less serious conditions. This can lead to delays in treatment, potentially worsening the outcome for the baby. Early detection is crucial for improving the chances of successful treatment and reducing the risk of complications.
Treating NEC can be challenging due to the complexity of the condition. The main goal of treatment is to relieve symptoms, prevent complications, and promote healing of the affected intestine. In mild cases, treatment may involve temporary cessation of feeding and the administration of antibiotics. In more severe cases, surgical intervention may be necessary. This can involve removing the damaged portion of the intestine or creating an opening in the abdomen to allow drainage of the infection. However, surgery carries its own risks and can have long-term consequences for the baby's digestive system.
Unfortunately, it is not uncommon for NEC to form the backdrop to a medical negligence claim. Most often, healthcare professionals have been negligent in failing to recognise the signs and symptoms of NEC or in delaying appropriate intervention.
We are currently instructed to represent the family of Baby T, who died four weeks after his birth due to complications of NEC. Baby T was born prematurely, at 28 weeks gestation, in very poor condition. He was cared for in neonatal intensive care immediately following his birth. Unfortunately, while the healthcare team in charge of his care had considered the possibility of NEC, they failed to arrange proper investigations, and assumed Baby T’s NEC to be mild. His doctors predominantly attributed his poor condition to an unrelated infection, for which he was treated with several courses of antibiotics.
Around four weeks after he was born, in the early hours of the morning, Baby T’s condition began to deteriorate very rapidly. Despite the best efforts of the clinicians, his condition became so critical that he went into cardiac arrest and died. A postmortem revealed that Baby T’s death was caused by sudden intestinal perforation (SIP), due to complications of NEC.
An examination of Baby T’s medical notes and records revealed that he had presented with signs and symptoms of severe NEC many days before his condition rapidly deteriorated. While our team’s investigations into the case are still ongoing, it seems that these symptoms should have prompted the nurses and doctors in charge of Baby T’s care to arrange surgical treatment. Had this been the case, Baby T’s NEC would have been treated before his condition became critical, and his death would have been avoided.
While there is an onus on healthcare professionals to consider and investigate the potential of NEC as soon as an infant displays possible symptoms of the condition, parents can play an important role in helping doctors detect NEC early. In particular, it is essential for parents to be vigilant and communicate any concerns or changes in their baby's health to the healthcare team. This will ensure that healthcare professionals are alerted to the possibility of NEC at the earliest possible stage.
It is also important for parents to educate themselves about the signs and symptoms of NEC and advocate for their baby's wellbeing. They can ask questions, seek second opinions, and actively participate in the decision-making process regarding their baby's care. They should also seek to ensure that their baby receives regular check-ups and screenings for NEC, especially if at higher risk due to prematurity.
Rosa Shand, associate in the clinical negligence team at Penningtons Manches Cooper, comments: “NEC is a serious and potentially devastating condition, most often seen in premature babies. The condition can be difficult to diagnose, especially if clinicians are not alive to subtle changes in a baby’s wellbeing, which means it can go undetected and therefore untreated for a long time. When this happens, affected infants can deteriorate suddenly and rapidly, leaving no time for effective intervention. Early detection is therefore crucial for successful outcomes. While doctors have ultimate responsibility for detecting NEC, given the difficulties and complexities in diagnosing the condition, parents should be encouraged to play a proactive role in helping doctors, by alerting them to signs of their baby’s discomfort or discontent and advocating for investigations where they have cause for concern.”
If you or a family member have any concerns regarding care provided during or shortly after childbirth, the Penningtons Manches Cooper team are here to provide specialist advice. Please contact us on freephone 0800 328 9545, email clinnegspecialist@penningtonslaw.com or complete our online assessment form. An initial, free, no obligation meeting will then be arranged.
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