What is Necrotizing Enterocolitis?

Relatively few people may have heard of necrotizing enterocolitis unless it has become a part of their own lives. Yet necrotizing enterocolitis is one of the most common gastrointestinal emergencies among preterm infants—those that are born at 32 weeks or less or weigh less than three and a half pounds are most likely to develop necrotizing enterocolitis.

In fact, about one in every 2,000-4,000 premature infants will be diagnosed with NEC; full-term, healthy babies rarely develop necrotizing enterocolitis. The disease, however, is not something that depends solely on chance. Studies—one that goes back to the 1990s—have found that when premature infants are fed a cow’s milk-based formula their risk of developing NEC goes up significantly.

Bovine-based baby formulas have been in use since the late 19th century. Cow’s milk is also used in fortifiers, often added to breast milk to boost its nutritional value. These cow’s milk-based formulas have, in particular, been given to preterm infants for decades. NICU nurses, doctors, and researchers began noticing a possible link between formula and fortifiers based on cow’s milk and necrotizing enterocolitis. And, in fact, today’s literature concludes that premature infants fed these bovine-based formulas or fortifiers are two to ten times more likely to develop necrotizing enterocolitis.

The 1990 study mentioned above found that formula-fed babies were from six to ten times more likely to develop necrotizing enterocolitis when compared to babies exclusively fed breast milk. In 2006, the World Health Organization found clear and consistent evidence that babies who were exclusively fed breast milk—full-term and pre-term babies—were much less likely to develop necrotizing enterocolitis. It is theorized that the underdeveloped digestive system of a pre-term infant is more likely to become inflamed and develop perforations in the intestine when fed a cow’s milk-based formula.

Abbott Laboratories and Mead Johnson are the two biggest manufacturers of bovine-based formulas, namely Similac and Enfamil. In fact, Similac and Enfamil have been the dominant formula brands for more than five decades, with both products accounting for almost 80 percent of the $4 billion-a-year market. Similac and Enfamil are also the brands most hospitals use for newborns and even send home samples of these formulas with parents.

Unfortunately, Mead and Abbott—along with other manufacturers of bovine-based formulas—have never warned parents or health professionals of the potential risks associated with these formulas. Despite the numerous studies that have found these cow’s milk-based formulas to be a significant risk to newborns, especially premature newborns, the manufacturers have failed to reveal the risks. As a result, there are many lawsuits filed against formula manufacturers because of this failure to warn.

What Are the Signs and Symptoms of Necrotizing Enterocolitis?

You may have noticed your infant becoming unwilling to eat, having a distended stomach, or that their stomach is red, purple, or bright pink. The baby may seem fussier than normal, extremely lethargic, and may either be constipated or have diarrhea, sometimes with blood.

When examined by a doctor, the baby’s belly could be extremely tender, or the doctor may feel a mass, which can indicate an intestinal perforation. An X-ray will be taken to determine whether the abdominal walls are inflamed and red. Should the X-ray show small bubbles in the wall of the intestine, necrotizing enterocolitis is likely. More severe cases of necrotizing enterocolitis may show air or gas in the large liver veins which are produced by bacteria in the wall of the bowel.

Your baby may vomit green bile or may have significant changes in heart rate, a low temperature, abnormal breathing patterns, or even apnea when the breathing momentarily stops. Low blood pressure, a jaundiced appearance, and metabolic acidosis can also be symptoms of necrotizing enterocolitis. Treatments for NEC may be medical or surgical—or both. If there is no perforation of the intestine, oral feeding may be stopped, administering nutrients and liquids through an IV. In some cases, a nasogastric tube extending from the nose into the stomach may be placed to suction air and fluids from the baby’s stomach and intestine to relieve swelling and discomfort.

Antibiotics will likely be given, either in response to a current infection or to stop any potential infection, with frequent blood tests performed to check for infection. If the swelling of the baby’s abdomen interferes with breathing, oxygen may be administered, or the baby may be placed on a ventilator. Platelet and red blood cell transfusions may be necessary in more severe cases of NEC.

Should the baby fail to respond to medical treatments, or in situations where there is a perforation in the intestine, surgery will be necessary to remove the necrotic portions of the intestine. If the surgeon sees parts of the intestine that are damaged—but not yet dead—they may be left, hoping the damage will heal. The surgeon may then perform a second surgery several days later to determine whether those damaged portions have healed or have died. The goal is to leave as much of the intestine as possible to minimize the long-term effects that NEC could have.

Are There Long-Term Effects of Necrotizing Enterocolitis?

Most infants will recover from NEC with no further issues. Some, however, will not be so fortunate. The babies that require surgical intervention to remove portions of the intestine are much more likely to experience long-term NEC effects. Babies that require surgery may develop narrowing of the bowel or scarring in the bowel which can cause future bowel obstruction or intestinal blockages. Some babies will develop NEC Totalis—the most severe and deadly form of necrotizing enterocolitis. The long-term health challenges that some babies with NEC may face include the following:

• Short bowel syndrome, also known as short gut syndrome, can occur when a significant portion of the intestines have been removed. Short bowel syndrome leaves the baby unable to absorb the crucial nutrients necessary to grow and thrive. The child may have to be fed through a feeding tube along with receiving IV fluids.
• The inability to properly absorb nutrients can cause a failure to thrive, which means the child will not grow at a normal rate and will likely be below his or her peers in height and weight.
• In some cases, NEC can cause neurodevelopmental delays, preventing the child from achieving normal childhood milestones. These neurodevelopmental delays can include hearing and vision issues, cognitive impairments, psychomotor impairments, and cerebral palsy.
• Among children who had NEC as an infant and were fed for prolonged periods through a feeding tube and IV, liver disease is often seen.
• Scarring within the intestine can lead to intestinal strictures.

How the Washington State NEC Statute of Limitations Could Affect Your NEC Baby Formula Lawsuit

The statutes of limitations are in place to limit the amount of time a person has to file a lawsuit for negligence that caused harm or injury or harm that results from a defective or dangerous product. The statutes vary from state to state, and, in some cases, according to the type of lawsuit. Some states incorporate the Discovery Rule, which can allow additional time to file a lawsuit in cases where the harm or injury was not discovered within the allotted time and could not reasonably have been discovered within that time.

Some states also incorporate the statutes of repose, which can allow extra time, usually for a product liability claim. If a statute of repose is in place, the time may begin to run from the time the product was manufactured, distributed, bought, or sold. Because the statutes of limitations and the potential exceptions can be complex, if you are considering a baby formula lawsuit, it can be helpful to contact an NEC baby formula lawsuit attorney. In Washington State, the following statutes of limitations apply:

• The personal injury statute of limitations in Washington is three years. The Discovery Rule applies in personal injury lawsuits when the injury was not apparent during the allotted time.
• Medical malpractice lawsuits in Washington must be filed by the latter of these two dates: Three years after the medical negligence that caused the victim’s injuries, or one year after the victim discovered, or should have discovered the error that led to the injury or harm.
• Wrongful death lawsuits in the state of Washington have a three-year statute of limitations. The Discovery Rule allows this time to be extended, based on the fact that the injury or harm was not discovered during the three years and could not have reasonably been discovered. Once the wrongful death is established, the three-year clock begins.
• Product liability lawsuits in the state of Washington have a three-year statute of limitations which begins to run on the date you discovered—or should have discovered—that you were injured by a dangerous or defective product. Washington also has a 12-year statute of repose for product liability lawsuits under the rebuttable presumption that the product is beyond its useful safe life if it is more than 12 years old.

How Can an Experienced NEC Baby Formula Lawsuit Attorney Help?

When your baby is diagnosed with necrotizing enterocolitis, you may feel helpless, worried, and anxious. Your baby’s health and future are your primary concern. When you later find out that your baby’s health issues could potentially have been avoided if the baby formula manufacturers had warned parents and medical professionals of the risks associated with feeding newborns cow’s milk-based formula.

There are currently baby formula lawsuits being filed across the United States with one MDL filed in Illinois that has 112 plaintiffs with more expected over the next few months and years. Having a knowledgeable NEC baby formula lawsuit lawyer from Sullo & Sullo by your side can make a significant difference in your family’s future. If you live in any of the following Washington state locales, you can benefit from speaking to our highly-skilled lawyers.

Seattle, Washington

Spokane, Washington

Tacoma, Washington

Vancouver, Washington

Bellevue, Washington

Everett, Washington

Kent, Washington

Yakima, Washington