Diseases of the colon in infants may occur for a variety of reasons. Some conditions are a result of infection, others may relate to a food sensitivity or allergy, and still others occur for reasons that are unclear. Although symptoms of these conditions may be similar---for instance, vomiting or diarrhea---establishing an accurate diagnosis is important so that affected infants can receive appropriate treatment.
Necrotizing Enterocolitis
Necrotizing enterocolitis, sometimes abbreviated as NEC, is a serious condition in which the tissue that lines the walls of the intestine dies and comes off of the intestinal wall. Physicians do not yet know what causes this disease, although being born prematurely increases the risk for developing it. Medline Plus, a service of the National Institutes of Health, describes the symptoms of NEC as a distended, or swollen, abdomen; diarrhea with blood in the stool; an inability to eat; vomiting; and lethargy, which is a state of listlessness in a baby who appears to be sleeping and is difficult to awaken. NEC is a serious illness: the NIH estimates that up to 25 percent of babies with NEC will die. Early and intensive treatment may help improve the outlook for a baby with NEC.
Treatment consists of several components: stopping all feeding, including breast milk; replacing feeding with intravenous fluids; removing gas from the intestine with a tube inserted into the stomach; and administering antibiotics to eliminate potentially dangerous bacteria in the intestines. If the intestinal wall has been perforated or the abdominal wall has also become inflamed, an infant will require surgery to remove the dead tissue from the colon. Aggressive treatment and monitoring using X-rays and blood tests increase the odds of survival.
Intussusception
Intussusception is a condition that occurs when part of the the intestine "telescopes" or folds into itself. Drs. Seiji Kitagawa and Mohamad Miqdady, writing in the medical reference "UpToDate," indicate that this condition is the most common abdominal emergency in children younger than 2. Doctors are unable to identify the cause of intussusception in about 75 percent of cases. Certain viruses may influence the development of the condition, however. For instance, a 2006 study of nearly 600 babies younger than 2 found a strong association between infection with a virus called adenovirus and the development of intussusception. The authors of the study conclude that adenovirus may play a role in this intestinal problem.
The symptoms of intussusception include episodes of abdominal pain that come on suddenly and repeat every 15 to 20 minutes. An infant may draw his legs up toward his abdomen and cry inconsolably. As time goes on the pain becomes worse and more frequent. Eventually vomiting may occur. Between bouts of pain and vomiting, an affected baby may seem normal and pain free; however, as the symptoms of intussusception continue, he will become more tired and listless.
Doctors diagnose intussusception with an ultrasound examination of the abdomen. Most often, the treatment for intussception is nonsurgical, and the child receives an enema---either with a contrast solution or with air. Drs. Kitagawa and Miqdady, summarizing the results of five studies, report that the success rate of this kind of treatment is 80 to 95 percent. If reducing the intussception with an enema fails, an infant may need surgery to correct the problem.
Protein-Induced Enterocolitis
Enterocolitis is a general term referring to inflammation of the small intestine and the colon, or large intestine. Milk-induced enterocolitis occurs when a baby is sensitive to the proteins contained in cow's milk. Similarly, in soy-induced enterocolitis, the inflammation occurs because a baby reacts to the soy proteins in soy milk or soy formula. In rare cases, even breast-fed babies can develop milk-induced enterocolitis because cow's milk proteins consumed by a baby's mother may pass through the breast milk and affect her child. This condition is relatively rare; the textbook "Current Diagnosis and Treatment: Pediatrics" estimates that between 0.5 and 1 percent of babies have difficulty with cow's milk protein. Of these babies, about one-third will also have difficulty digesting soy protein.
Symptoms of protein-induced enterocolitis include blood in the stool, vomiting and diarrhea. Treatment usually involves switching to a formula called protein hydrosylate. Babies with symptoms that are especially severe may require another kind of formula, called semi-elemental formula. By the age of 1, most infants outgrow this sensitivity and tolerate milk and soy without difficulty.
References
- "Current Diagnosis and Treatment: Pediatrics"; W. Hay et. al.; 2006
- Medline Plus: Necrotizing Enterocolitis
- "Journal of Pediatrics"; Risk Factors for Intussusception in Infants in Vietnam and Australia: Adenovirus Implicated, but Not Rotavirus; J. E. Bines, et. al.; October 2006
- "UpToDate"; Seiji Kitagawa and Mohamad Miqdady; 2010
