Necrotizing enterocolitis

Abstract Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency affecting predominantly preterm babies. Prenatal risk factors include absent/reversed end-diastolic flow and placental insufficiency. In the postnatal period, prematurity, hypoxic/ischaemic events, infection, feeding, and cardiac disease are implicated. NEC is characterized by intestinal barrier disruption, bacterial overgrowth, and submucosal invasion of organisms, leading to necrosis of the intestinal wall, perforation, peritonitis, sepsis, and death. Early clinical presentation includes lethargy, feed intolerance, and abdominal distension, which may progress to a surgical abdomen with abdominal wall discoloration, blood in the stool, peritonitis, and generalized instability. Pneumatosis intestinalis on an abdominal radiograph is diagnostic of NEC. Initial management includes gut rest, antibiotics, and parenteral nutrition, and if progressive, surgical intervention. A variety of surgical options are available, dictated by the general condition of the patient and the operative findings. Overall surgical mortality exceeds 40%.