Necrotizing Enterocolitis

Necrotizing Enterocolitis (NEC) is a devastating disease that primarily affects the premature neonatal intestine, leading to necrosis, sepsis and death. Although the pathophysiology of NEC is incompletely understood, inflammatory mediators, such as TNF-α, along with an immature intestinal barrier and bacterial pathogens play a crucial role in the development of NEC. The presentation may include non-specific findings, such as irritability, feeding intolerance and abdominal distention, and it can quickly progress to pneumoperitoneum and peritonitis. The modified Bell’s staging system is a tool to assist with the diagnosis of NEC, based on systemic, abdominal and radiographic signs. Most infants with NEC are treated with medical management; however, approximately 30–50% of these will go on to require surgical intervention. Despite advancements in prevention, mortality rates of infants diagnosed with NEC remain high, at approximately 35% in surgical and 20% in medical NEC. Among survivors, long-term complications include short bowel syndrome, strictures and neurodevelopmental delay. Despite advances in the care of premature infants, NEC continues to be one of the deadliest diseases of neonates.