Definitions, Diagnostic Strategies and Management of Suspected Necrotizing Enterocolitis (Bell Stage I) in Preterm Infants ≤32 Weeks’ Gestation: A Scoping Review

Background Suspected necrotizing enterocolitis (NEC) or Bell stage I is frequently diagnosed in preterm infants but remains poorly standardized regarding definition, diagnostic evaluation and therapeutic management. Despite being traditionally considered a benign or transitional condition, emerging registry data suggest possible associations with adverse outcomes. Clinical practice varies substantially across institutions, particularly regarding imaging strategies, antibiotic use, bowel rest duration, and refeeding protocols. Objective To systematically map current definitions, diagnostic work-up strategies, and management approaches for suspected NEC / Bell stage I in preterm infants ≤32 weeks’ gestation. Review Type Scoping review conducted in accordance with PRISMA-ScR. Eligibility Criteria Population Preterm infants ≤32+0 weeks’ gestation. Concept Suspected NEC, NEC rule-out, Bell stage I (including IA/IB). Context NICU settings; all countries, languages, and time periods. Study types Observational studies, interventional studies, clinical pathways, institutional protocols from peer institutions, and clinical guidelines. Exclusion Studies reporting only confirmed NEC (Bell II/III) without separate data for stage I. Case reports with n < 5. Animal studies. Studies addressing only feeding intolerance without reference to suspected NEC. Information Sources MEDLINE (PubMed) Embase Cochrane CENTRAL Web of Science / Scopus Structured web search for institutional clinical pathways (peer institutions only) Outcomes (if reported) Diagnostic criteria Imaging strategy (radiography, abdominal ultrasound) Antibiotic regimens and duration Bowel rest duration Refeeding protocols Reported progression and mortality (if available) Data Charting Two independent reviewers will screen titles/abstracts and full texts. Data will be extracted using a piloted standardized form.