A 6-day-old baby with a rare intestinal infection and Necrotizing Enterocolitis was saved with timely surgery

When a 6-day-old Rahul (name changed) was brought to Sarvodaya Hospital, his parents were deeply worried. The baby had stopped feeding, his abdomen had started swelling, and he was vomiting greenish fluid. He was immediately admitted to the NICU with neonatal sepsis, a serious bloodstream infection in newborns.

Blood investigations indicated infection, and the culture later grew Klebsiella, confirming bacterial sepsis. Despite intensive medical management, the baby’s condition began to worsen. A follow-up abdominal X-ray showed progressive air-fluid levels — a red flag in newborns.

Further evaluation confirmed a life-threatening diagnosis: Necrotizing Enterocolitis (NEC), one of the most serious gastrointestinal emergencies in newborns.

Although NEC is commonly seen in premature babies, whose intestines are immature and immunity underdeveloped, this case was rare as the baby was full-term. Term babies are less commonly affected, but when NEC occurs in them, it can progress aggressively, especially in the presence of sepsis.

In early stages, NEC can sometimes be managed with stopping feeds, IV antibiotics and intensive monitoring; however, in this baby’s case, the disease progressed rapidly despite medical management. Surgery became the only life-saving option.

A High-Risk Emergency Surgery

After careful assessment of worsening clinical and radiological signs, Dr Shweta K. Sharma, Consultant - Paediatric Surgery and her paediatric surgical team decided to proceed with emergency exploration.

During laparotomy, the findings were alarming: Multiple patchy necrotic (dead) segments of small intestine were identified at different levels, and nearly 3–4 segments were gangrenous  (died due to lack of blood flow or severe infection).

This meant the intestine had already lost its blood supply, and immunity had failed to contain the infection.

Two necrotic (dead) segments were resected and joined back together (resection and anastomosis). Another severely gangrenous segment was removed. A double-barrel ileostomy was created to divert intestinal contents and allow healing.

The surgery was long and complex, requiring extended anaesthesia support due to the baby’s fragile condition.

Given that multiple NEC carries a mortality rate of 80–90%, the case was extremely high risk.

Another Rare and Unique Finding: Mucormycosis

An unexpected and rare discovery came from the histopathology of the removed intestinal segment. The tissue tested positive for Mucormycosis, a rare and aggressive fungal infection.

Early detection by Dr. Deepika Parwan, HOD and Senior Consultant, Histopathology, in the laboratory allowed prompt initiation of antifungal therapy (Amphotericin B). This timely intervention played a crucial role in preventing further systemic spread of the fungal infection — a rare complication in neonatal NEC.

Post-Operative Care and Recovery

The baby was shifted to the NICU postoperatively. Remarkably, the stoma (small opening made by doctors on the stomach area (abdomen) to help the body remove waste) started functioning by postoperative day 3.

Feeds were gradually restarted and escalated carefully. His recovery began steadily.

At around two months of age, the stoma was successfully closed. Today, the baby is thriving,  a remarkable turnaround from a life-threatening start.

Understanding Necrotizing Enterocolitis (NEC)

NEC is an inflammatory condition of the intestine seen in newborns, where portions of the bowel undergo necrosis due to infection, poor blood supply, and immature gut immunity. It is a condition where infection and inflammation cause destruction (necrosis) of the intestinal wall. If not treated in time, parts of the intestine can become gangrenous, leading to perforation, severe infection, and death.

How Common is NEC?

NEC is relatively common in preterm infants, especially those with:

• Low birth weight
• Early-onset sepsis
• Formula feeding
• Prolonged NICU stay
  

However, multiple NEC in a full-term baby with associated fungal infection is rare and significantly more dangerous.

Causes of NEC

The exact cause is multifactorial:

• Immature gut immunity
• Bacterial infection (like Klebsiella)
• Sepsis
• Reduced blood supply to the intestine
• Abnormal bacterial colonisation
  

When the intestinal lining is weak, bacteria invade the wall, causing inflammation, gas formation, and eventually necrosis.

Symptoms of NEC

Parents and doctors should watch for:

• Refusal to feed
• Green (bilious) vomiting
• Abdominal distension
• Blood in stool
• Lethargy
• Temperature instability
  
  

If babies stop feeding, do not force-feed them. When intestines are already inflamed, pushing milk can worsen infection and accelerate necrosis.

Immediate consultation with a paediatrician or paediatric surgeon is critical.

Why Timely Treatment Matters?

If NEC is not identified early:

• The entire intestine can become gangrenous
• Intestinal perforation may occur
• Severe sepsis develops
• Mortality risk increases drastically
  
  

Delayed treatment can also result in long-term complications like:

• Short bowel syndrome
• Need for prolonged Total Parenteral Nutrition (TPN)
• Growth failure
  

In this case, proactive monitoring, timely surgical decision-making, and multidisciplinary teamwork prevented catastrophic outcomes.

Role of a Paediatric Surgeon

A paediatric surgeon plays a vital role in:

• Early recognition of progressive NEC
• Determining optimal timing for surgery
• Planning bowel preservation to prevent short bowel syndrome
  
  
• Performing delicate intestinal reconstruction
• Coordinating postoperative care with neonatologists
  

Equally important is strong collaboration between paediatricians, anaesthetists, pathologists, and NICU nursing teams. In this case, seamless coordination ensured survival in what was initially a moribund baby.

A Message for Parents

NEC is common in NICUs, especially among premature babies,  but term babies are not completely immune.

If your newborn stops feeding, vomits green fluid and develops abdominal swelling, seek immediate medical care. Early intervention can make a difference and can save the baby’s life.