Cocaine: a risk factor for necrotizing enterocolitis.

Necrotizing enterocolitis occurs most often in the small preterm infant, usually with birthweight less than 1.5 kg. Necrotizing enterocolitis has also been described in more mature infants, however, often the result of reduced gastrointestinal blood flow. We describe four relatively large infants from our nursery with varying severity of necrotizing enterocolitis. None had any of the known risk factors; all had a history of maternal cocaine use. Two were initially cared for in the term nursery. All four presented with abdominal distention, bloody stools, vomiting, or residuals. One infant presented with fulminant deterioration and subsequently died; the other three infants were treated medically and survived. It is suggested that a high index of suspicion be maintained for the possibility of necrotizing enterocolitis and feeding intolerance in term and near-term infants exposed in utero to cocaine.