Necrotizing Enterocolitis as a Rare Complication of Severe RSV Bronchiolitis in a Term Neonate: A Case Report With Narrative Review

Abstract

Respiratory syncytial virus (RSV) bronchiolitis is a leading cause of hospitalization in early infancy, whereas necrotizing enterocolitis (NEC) is rare in term neonates without risk factors. We report a previously healthy, full-term 24-day-old neonate admitted with severe RSV bronchiolitis who developed sudden deterioration with abdominal distension, metabolic acidosis, septic shock, and imaging consistent with advanced NEC, ultimately resulting in death despite intensive medical and surgical management. To contextualize this association, we conducted a narrative review of case reports and small series describing NEC during RSV infection. Available evidence suggests that RSV-associated NEC is uncommon but highly morbid, typically arising during critical illness and often after initiation of enteral feeding. Although causality remains uncertain, systemic inflammation and gut–lung axis interactions may contribute to pathogenesis. This case highlights the need for heightened vigilance for gastrointestinal complications in infants with severe RSV who develop abdominal signs or unexplained hemodynamic instability.