Preventing Necrotizing Enterocolitis: What Works and How Safe?

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.¹ 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,² although apparent cases were reported much earlier, in the 19th century.³ 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.⁴ Early animal models of NEC are consistent with this theory.⁵ More recent thought adds the possible role of vasoconstriction in response to inflammatory or other stimuli.⁶

Despite our limited knowledge of the pathogenesis of NEC, various strategies have been tried in an effort to prevent NEC in high-risk …

Address correspondence to Edward F. Bell, MD, Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail: edward-bell{at}uiowa.edu