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NEC Part 2: Signs and Symptoms 

Blog
May 18, 2025•2 min read

NEC Awareness Part 2

In part 1 of our NEC series, we explored risk factors associated with necrotizing enterocolitis (NEC)—one of the most devastating gastrointestinal conditions affecting our NICU babies.

Today, we’re diving into part 2: Signs and Symptoms Every NICU Nurse Should Know. Whether you’re a new grad or a seasoned nurse, knowing how NEC presents—especially in its earliest stages—is critical to timely recognition and intervention.

👶 What is NEC Again?

Necrotizing Enterocolitis (NEC) is an inflammatory disease that causes intestinal tissue to die. It primarily affects premature and medically fragile infants, and it can progress rapidly.

Time is gut—early identification can lead to early intervention and better outcomes.

🩺 Early GI Symptoms: The Subtle Clues

NEC often begins with subtle, nonspecific gastrointestinal signs. These may seem mild but should raise suspicion:

  • Increased gastric residuals

  • Feeding intolerance or sudden change in tolerance

  • Abdominal distention or firmness

  • Vomiting (especially bilious or green)

  • Decreased bowel sounds

Even just a “gut feeling” that something is off during cares or feedings is worth a second look.

🌡️ Systemic & Neurological Changes: Things Are Escalating

As NEC progresses, the baby may show more systemic signs of illness:

  • Apnea, bradycardia, or desaturations

  • Lethargy or decreased tone

  • Temperature instability

  • Pallor or poor perfusion

  • Glucose instability (especially hypoglycemia)

Remember: NEC isn’t just a gut issue. It can quickly affect the whole body.

🚨 Red Flags: Late Signs That Signal Emergency

These signs often indicate worsening or advanced NEC—and need urgent provider evaluation:

  • Bloody stools

  • Discoloration or erythema of the abdominal wall

  • Metabolic acidosis

  • Capillary refill >3 seconds

  • Signs of sepsis (hypotension, abnormal labs)

🧠 Keep in Mind:

  • NEC can develop even in term infants, especially those with congenital heart disease or recent illness.

  • Transfusions, recent antibiotic use, or enteral feedings after NPO status are notable risk factors.

  • Parental observations can also provide important clues—don't ignore them.

📌 Final Thoughts

Early recognition is everything. You know your babies—if something feels wrong, speak up.
Review signs regularly with your team and during bedside teaching. Keep this knowledge accessible.

And come back for part 3!

🔁 ICYMI: Review our previous NEC education post on Risk Factors here
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📱 Follow @nicueducator.lisa for more NICU education each week.

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