Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality among premature infants, affecting 4% to 13% of very low birth weight (VLBW) infants. The incidence varies among institutions and over time within each institution, occurring at times in outbreaks suggesting transmission among patients. The incidence of NEC varies inversely with pregnancy length, being more common in infants of younger gestational age. Reports of cases identified as NEC appeared in the 1960s, although apparent cases were reported much earlier, in the 19th century. A single cause has not been identified, suggesting that NEC results from various triggering events under certain predisposing conditions: a final common pathway. The leading theory is that NEC requires 3 coexisting elements: inadequate oxygen transport to the gut, potentially invasive pathogenic bacteria, and substrate in the form of enteral feedings. Early animal models of NEC are consistent with this theory.5...

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