Necrotizing enterocolitis (NEC) remains one of the leading complications of prematurity with an incidence of 5% to 13% and a mortality of up to 30%. Its occurrence is inversely related to gestational age, with the most premature neonates being at highest risk. Despite numerous studies assessing risk factors, the most commonly observed associations remain prematurity and enteral feeding. Furthermore, studies have pointed to receipt of breast milk as a protective factor in decreasing the risk of NEC and formula feeding as potentially increasing the risk. Other potential risk factors and associations in the premature infant include lack of antenatal steroids, receipt of prolonged courses of postnatal antibiotics, presence of anemia, receipt of packed red blood cell transfusions, and presence of a patent ductus arteriosus. Despite the recognition that NEC remains a serious complication of prematurity, there is still no specific prescription for its prevention. Given that enteral feeding is one of the most commonly observed risk factors for the development of NEC, wide variation exists in the enteral feeding recommendations and practices for premature infants. Feeding practices that may contribute to NEC, which remain variable in practice, include feeding strategies used in the presence of a hemodynamically significant patent ductus arteriosus and feeding during packed red blood cell transfusions. Use of breast milk (mother’s own milk or donor milk) is recognized as one of the mainstays of NEC prevention. This article explores multiple influences of feeding on the development of NEC.

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