**10. Complications**

The acute complications of NEC are sepsis, meningitis, peritonitis, intraabdominal abscess formation, DIC, thrombocytopenia, hypotension, shock, respiratory failure, metabolic or combined acidosis, hyponatremia, hyperglycemia, or less often hypoglycemia. Late complications are stricture formation, short bowel syndrome, and intestinal failure [55]. Rarely enterocele, enterocolic fistula, and intraabdominal abscess formation may be encountered. About 24% (95% CI 17–31%) of infants treated medically or surgically develop strictures in bowel which is unrelated to the severity of NEC or gestational age. The commonest location is in the colon, followed by the ileum and jejunum. Multiple sites strictures are seen. It can appear within 2 to 3 months of the acute episode and as late as 20 months. Stricture may lead to local bacterial overgrowth resulting in repeated infections, bloody stools, failure to thrive, and symptoms of bowel obstruction. Strictures are more common following enterostomy; therefore contrast enemas should be performed 4–6 weeks after the occurrence of NEC and prior to surgical closure of enterostomy with reanastomosis or if and when feeding intolerance develops. Recurrent NEC may occur in 8% and adhesion ileus in 6% cases of NEC. Overall intestinal failure happens in 13% of all cases of NEC, inclusive of medically and surgically treated infants.
