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Necrotising enterocolitis: protecting newborn babies from this life-threatening bowel problem

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What did the project achieve?

“Our findings weakly support existing evidence to suggest that feeding premature babies with anything other than just breast milk, may increase the chances of developing a life-threatening bowel condition,” says Professor Ed Juszczak who led the study at the University of Oxford. “However, quite unexpectedly, we found stronger evidence that giving non-breast milk feeds within the first 28 days of life was associated with a lower risk of serious infections later.”

“As it’s possible that this is a chance finding, further studies involving larger numbers of babies are now needed to make more definite conclusions – as it’s important that these tiny babies get the right nutrition that gives them the best chance to thrive.”

Necrotising enterocolitis (NEC) is a serious inflammatory bowel condition that can affect newborn babies. Premature babies are among those who are most susceptible to developing this life-threatening condition. Sadly, some will die – and those who survive can be left with long-term complications that affect their quality of life.

The reasons why some babies develop NEC aren’t clear, but we do know that the condition is less common in babies fed with breast milk rather than formula. However, breast milk doesn’t always provide all the nutrients that very premature babies need to grow healthily – and so it is often fortified with extra nutrients, or babies are given formula milk.

Professor Juszczak and his team looked at data collected from a previous clinical trial to investigate whether giving tiny premature babies other types of milk, other than exclusively breast milk, could affect their chances of developing severe NEC and serious infections.

“Studies like this are important to further understanding and knowledge of how to effectively feed premature babies – to minimise their risk of developing serious illnesses while also optimising nutrition and growth,” says Professor Juszczak.

This research was completed on

Evidence suggests hundreds of babies develop a serious bowel problem called necrotising enterocolitis (NEC) each year in the UK.1-6 Babies with NEC need urgent treatment, often involving emergency surgery. Sadly, many babies with NEC lose their lives and some of those who survive suffer long-term complications, such as persistent bowel problems, poor growth and learning difficulties.7 Researchers at the Universities of Oxford and Southampton, led by Associate Professor Ed Juszczak, are investigating how different milk feeds and food supplements affect babies’ chances of developing NEC, in the hope of better understanding why so many babies still develop this devastating condition.

How are babies’ lives affected now?

Up to one in 20 babies in neonatal units develops NEC.4 Premature babies, those with a very low birth weight and babies who are already poorly are the most susceptible to this life-threatening condition.

NEC happens when the lining of a baby’s intestines becomes inflamed and starts to die. The exact cause of this is unknown.

“Babies with NEC usually become extremely unwell and need urgent treatment,” says Mr Nigel Hall. “Babies often need emergency surgery to remove damaged parts of the bowel.”

NEC is in fact the most common reason for emergency surgery in newborn babies.8 Babies who survive surgery often have to stay in hospital for a long time afterwards. Consequences of NEC during childhood include problems with nutrition and growth, learning difficulties, and problems with hearing, vision and movement.

“Sadly, NEC remains a significant cause of death and suffering in premature babies,” says Professor Juszczak. “A better understanding of this devastating condition is needed urgently.”


How could this research help?

The researchers are investigating whether the way babies are fed affects their chances of developing NEC.

“Babies who are at high-risk of developing NEC tend to be given breast milk first, because evidence suggests breast milk is protective against the condition,” says Mr Hall. “However, breast milk doesn’t always provide all the nutrients that very premature babies need to grow healthily, so breast milk is often fortified with extra protein, vitamins and minerals, or babies are given formula.”

The team is investigating whether babies’ chances of developing NEC increase if breast milk is fortified, or if they’re given formula milk, or if the type of milk they’re being given is changed.

The ultimate goal is to find out whether changes in feeding practices could reduce babies’ chances of developing NEC, so protecting them from suffering and saving their lives.


1. Office for National Statistics. Statistical bulletin: Birth Summary Tables, England and Wales: 2015. Live births, stillbirths, and the intensity of childbearing measured by the total fertility rate. Website accessed 15 August 2016.

2. ISD Scotland Data Tables (2015 data). Maternity and Births. Table 5 - Live births (all, singleton and multiple) by birthweight and gestation. Website accessed 15 August 2016.

3. Northern Ireland Statistics and Research Agency. Births. Live births 1887-2014. Website accessed 15 August 2016.

4. Rees CM et al. Trends in infant mortality from necrotising enterocolitis in England and Wales and the USA. Arch Dis Child Fetal Neonatal Ed 2008;93:F395-F396.

5. Child Trends Databank. Percentage of infants born at a low or very low birthweight, 1970-2013. Website accessed 9 September 2016.

6. Personal communication.

7. MedlinePlus. Necrotizing enterocolitis. Website accessed 3 August 2016.

8. Great Ormond Street Hospital for Children. Necrotising enterocolitis. Website accessed 3 August 2016.




Project Leader Associate Professor Ed Juszczak BSc(Hons), MSc, CStat CSci
Project Team Associate Professor Nigel Hall MB BChir MRCPCH PhD FRCS [University of Southampton (UoS)]Dr Alison Leaf MD, FRCPCH (UoS)Ms Louise Linsell BSc (Hons) MSc DPhil (UoO)Dr Christopher Partlett BSc PhD (UoO)
Project Location National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (UoO)
Project Location Other Department of Paediatric Surgery, Southampton General Hospital, University of Southampton,Department of Child Health, Southampton General Hospital, University of Southampton
Project duration 1 year
Date awarded 21 July 2016
Project start date 1 January 2017
Project end date 31 December 2018
Grant amount £26,262
Grant code GN2506
Born Too Soon - Fighting NEC

Fighting NEC

Have you been affected by Necrotising enterocolitis?


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