Necrotizing Enterocolitis

NEC: gas bubbles forming in the bowel wall
NEC: gas bubbles forming in the bowel wall
Advanced NEC: a segment of dead bowel removed at surgery
Advanced NEC: a segment of dead bowel removed at surgery

Table of Contents

  1. Overview — What Is NEC?
  2. Risk Factors
  3. Signs and Symptoms
  4. Diagnosis: Bell's Staging Criteria
  5. Medical Management
  6. Surgical Management
  7. Prevention
  8. Long-Term Outcomes for Families
  9. Key Research Papers
  10. Connections

Overview — What Is NEC?

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in newborn infants and one of the most devastating diseases affecting premature infants (Lin and Stoll 2006). The disease causes portions of the intestine to become inflamed and injured; in its advanced form the bowel can perforate, leading to peritonitis and systemic illness with low blood pressure that needs intensive medical support, surgery, or both (Neu and Walker 2011). For families in the NICU, a NEC diagnosis is a frightening moment. Understanding what is happening inside the baby's body, and why, can help families follow the care team's decisions.

Large neonatal network databases from the United States and Canada put the mean prevalence at about 7% among infants with a birth weight between 500 and 1,500 grams, and the estimated rate of death associated with NEC ranges between 20 and 30%, with the highest rate among infants who need surgery (Neu and Walker 2011). A 2020 meta-analysis of 27 cohort studies (574,692 newborns) gave a similar pooled incidence of 7.0% among very low birth weight (VLBW) infants in NICUs, with considerable variation between studies (Alsaied 2020). In a whole-population study in England in 2012–13, 3.2% of babies born before 32 weeks developed severe NEC (confirmed at laparotomy or fatal), and 46.5% of all babies with severe NEC died (Battersby 2017).

The cause of NEC is incompletely understood. Reviews describe several interacting factors in premature infants (Neu and Walker 2011):

  1. Intestinal immaturity — immature motility, digestion, barrier function, immune defenses and circulatory regulation, together with an excessive inflammatory response of the immature intestine to bacteria.
  2. Abnormal bacterial colonization — molecular studies of stool from preterm infants suggest NEC is associated with unusual intestinal microbial species and reduced diversity of the microbiota, especially after prolonged antibiotic therapy.
  3. Blood-flow regulation — hypoxia–ischemia was once considered the primary contributor; the review describes major perinatal hypoxic–ischemic events as now considered unlikely to contribute substantially, while imbalances in microvascular tone (nitric oxide, endothelin) probably play a downstream role.

A 2009 historical review traced reports of NEC back to foundling hospitals in Paris in 1828 and concluded that its pathogenesis remains unclear after 150 years of research (Obladen 2009). Classic NEC in preterm infants does not occur until at least 8 to 10 days after birth, and the more premature the infant, the later the condition tends to appear (Neu and Walker 2011).

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Risk Factors

NEC is primarily a disease of premature infants (McElhinney 2000), and most of the risk factors studied either reflect or compound that immaturity.

Prematurity and Low Birth Weight

Very low gestational age was a risk factor in the 1990 multicentre study of 926 preterm infants (Lucas and Cole 1990), and reviews describe classic NEC as an inflammatory intestinal condition of prematurely born infants (Neu and Walker 2011).

Formula Feeding

The type of milk a premature infant receives is strongly associated with NEC risk. In the prospective multicentre study by Lucas and Cole (926 preterm infants formally assigned to their early diet), confirmed NEC was 6 to 10 times more common in exclusively formula-fed babies than in those fed breast milk alone, and 3 times more common than in those who received formula plus breast milk; pasteurised donor milk seemed to be as protective as raw maternal milk (Lucas and Cole 1990). In England in 2012–13, babies born before 32 weeks who received their own mother's milk within 7 days of birth had a lower risk of severe NEC (relative risk 0.69), although the authors described the absolute reduction as small (Battersby 2017). Donor human milk is proposed to retain the non-nutritive benefits of maternal milk (Quigley 2024).

Intrauterine Growth Restriction (IUGR)

In a UK cohort of 206 preterm babies, absent or reversed end-diastolic flow on antenatal umbilical Doppler — a marker of antenatal gut ischaemia — was strongly associated with later NEC (odds ratio 5.88), and the association held after adjustment for gestational age and for birthweight z-score (Kamoji 2008).

Congenital Heart Disease

Among term infants, congenital heart disease may be an important predisposing factor. In a cohort of 643 neonates with heart disease, hypoplastic left heart syndrome (odds ratio 3.8) and truncus arteriosus or aortopulmonary window (odds ratio 6.3) were independently associated with NEC, and earlier gestational age and episodes of low cardiac output or shock remained associated in multivariable analysis (McElhinney 2000).

Transfusion-Associated NEC (TANEC)

The link between red blood cell (RBC) transfusion and NEC is debated. A 2012 meta-analysis of eleven retrospective case-control studies and one cohort study found that recent exposure to transfusion (within 48 hours) was associated with NEC; infants who developed transfusion-associated NEC were younger and smaller, more likely to have a patent ductus arteriosus, and had higher mortality (Mohamed and Shah 2012). Later prospective data point the other way: a case-control study by Sharma and colleagues found no temporal association between transfusion and NEC in the 48 hours or 7 days before onset (Sharma 2014), and a prospective multicentre cohort of 598 VLBW infants found that severe anemia (hemoglobin 8 g/dL or less), but not RBC transfusion, was associated with NEC (adjusted hazard ratio 5.99) (Patel 2016). How transfusion might affect intestinal blood flow is unclear (Neu and Walker 2011).

Polycythemia

Polycythaemia was among the additional risk factors identified in the 1990 Lucas and Cole study, together with respiratory disease and umbilical artery catheterisation (Lucas and Cole 1990).

Antibiotic Exposure and Microbiome Disruption

In 4,039 extremely low birth weight infants with sterile initial cultures, prolonged initial empirical antibiotic therapy (5 days or more) was associated with increased odds of NEC or death, and each additional day of empirical treatment was associated with increased odds of NEC (Cotten 2009). Reduced microbial diversity after prolonged antibiotic therapy is one proposed explanation (Neu and Walker 2011).

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Signs and Symptoms

NEC can progress rapidly, often within hours, from subtle signs to a critical illness (Neu and Walker 2011). The NICU team watches continuously for a combination of intestinal and whole-body signs; knowing what the team is watching for helps explain why a baby's care plan can change quickly.

Early Signs

The most typical early signs of classic NEC in a preterm infant are feeding intolerance, abdominal distension, and bloody stools after 8 to 10 days of age (Neu and Walker 2011). Reviews of the clinical spectrum also list temperature instability, apnea, lethargy, bilious residuals and guaiac-positive (occult blood) stools (Coit 1999). Almost all VLBW infants have intermittent symptoms such as abdominal distension, heme-positive stools and feeding intolerance at some point, and most of them do not have NEC (Neu and Walker 2011).

Signs of Advanced NEC

Advanced disease can bring abdominal discoloration, intestinal perforation and peritonitis, leading to systemic hypotension (Neu and Walker 2011); at the severe end of the spectrum are septic shock and disseminated intravascular coagulation (Coit 1999). A falling platelet count, a falling neutrophil count, or shock are among the changes that prompt surgical evaluation (Neu and Walker 2011).

What Families May Notice at the Bedside

Several of these signs — blood in the stool, a belly that looks newly swollen, and a baby who is much less active than usual — are visible to parents at the bedside. Questions about any change belong with the baby's nurse and the NICU team.

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Diagnosis: Bell's Staging Criteria

NEC is diagnosed from a combination of clinical signs, blood tests and imaging. A staging system was proposed by Bell and colleagues in 1978 (Bell 1978) and later refined; it has three stages (Neu and Walker 2011). Its adequacy has long been debated: Gephart and colleagues argued that a better global definition of NEC is needed, proposed a simple bedside "Two out of Three" rule, and reviewed candidate biomarkers (Gephart 2018).

Stage I — Suspected NEC

Stage 1 criteria are highly nonspecific findings, such as feeding intolerance, mild abdominal distension, or both (Neu and Walker 2011). In Bell's original series, Stage I infants received diagnostic and supportive measures, and all of them survived (Bell 1978).

Stage II — Confirmed NEC

Stage 2 rests on radiographic findings such as pneumatosis intestinalis — gas within the bowel wall — which may be hard to detect on radiographs (Neu and Walker 2011). The review describes pneumatosis intestinalis, portal venous gas, or both as the pathognomonic findings of NEC on abdominal radiography. In Bell's scheme, Stage II infants were treated medically (Bell 1978).

Stage III — Advanced NEC

One of the most important Stage 3 criteria is a perforated bowel, shown by free air outside the bowel (pneumoperitoneum); a perforation may or may not reflect intestinal necrosis and could instead be a spontaneous intestinal perforation, a distinct condition (Neu and Walker 2011). In Bell's 1978 scheme, Stage III patients required an operation, and 32 of 38 Stage II and III infants (85%) survived the acute episode (Bell 1978).

Imaging Studies

Laboratory Findings

No single blood test defines NEC; the lack of reliable diagnostic criteria is one reason researchers are looking for biomarkers (Neu and Walker 2011; Gephart 2018). Shock or a decreasing platelet count, neutrophil count, or both are among the biochemical changes the review lists as markers of deterioration (Neu and Walker 2011).

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Medical Management (Stage I–II)

Medical treatment of definite NEC typically includes abdominal decompression, bowel rest, broad-spectrum intravenous antibiotics, and intravenous nutrition, with close monitoring for signs that surgery is needed (Neu and Walker 2011).

Bowel Rest

Feedings are stopped and a tube is used to decompress the stomach (Neu and Walker 2011). How long feeds are withheld varies. A 2020 meta-analysis of three observational studies (no randomized trials) found that earlier re-initiation of feeds after NEC (median about 4 days, versus about 10 days) was associated with a lower combined rate of recurrent NEC or post-NEC stricture, with no increase in negative outcomes (Patel 2020).

Intravenous Nutrition

While the bowel rests, nutrition is given intravenously as parenteral nutrition ("intravenous hyperalimentation") (Neu and Walker 2011).

Intravenous Antibiotics

Broad-spectrum intravenous antibiotics are standard (Neu and Walker 2011); Bell's 1978 series used parenteral and gavage aminoglycoside antibiotics and the authors supported combination antimicrobial therapy (Bell 1978). A Cochrane review found only two small randomized trials of antibiotic regimens for NEC — ampicillin and gentamicin with or without clindamycin, and ampicillin and gentamicin with or without enteral gentamicin — and concluded that the evidence was insufficient to recommend any particular regimen; the clindamycin arm showed a trend toward more strictures (Shah and Sinn 2012).

Monitoring and Supportive Care

Infants are monitored closely for perforation or a deteriorating clinical or biochemical status — shock, a falling platelet count or neutrophil count — which are the usual indications for surgery; advanced disease can require intensive medical support for low blood pressure (Neu and Walker 2011). Spontaneous intestinal perforation, a condition the review treats as separate from classic NEC, has been associated with indomethacin and with glucocorticoids such as dexamethasone or hydrocortisone (Neu and Walker 2011).

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Surgical Management (Stage III / Perforation)

When NEC progresses beyond what medical management can control, surgery becomes necessary. This is one of the most difficult conversations NICU families face; the surgical team explains the specific plan, and the information below provides context for that conversation.

Surgical Indications

Surgery is generally required for intestinal perforation or for a deteriorating clinical or biochemical status, such as shock or a decreasing platelet count, neutrophil count, or both (Neu and Walker 2011).

Surgical Options

Procedures include drain placement, exploratory laparotomy with resection of diseased bowel, and enterostomy with creation of a stoma (Neu and Walker 2011). Laparotomy and primary peritoneal drainage without laparotomy are the two commonly compared approaches for advanced NEC with perforation, and their relative benefits have been controversial:

Short Bowel Syndrome

The need for bowel resection is one of the most common severe complications of NEC and the major cause of short bowel syndrome (SBS) in children, a condition in which the remaining intestine cannot absorb enough nutrition; the total mean cost of care over 5 years for a child with SBS has been estimated at nearly $1.5 million (Neu and Walker 2011).

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Prevention

Given the consequences of NEC, prevention is a major focus of neonatal research, and reviews note that preventive approaches are likely to yield better results than new treatments (Neu and Walker 2011). The strength of the evidence differs a great deal between interventions.

Human Breast Milk

In the 1990 Lucas and Cole study of 926 preterm infants, confirmed NEC was 6 to 10 times more common in exclusively formula-fed babies than in babies fed breast milk alone, and 3 times more common than in babies who received formula plus breast milk (Lucas and Cole 1990). Among babies born at more than 30 weeks' gestation, confirmed NEC was rare when the diet included breast milk and 20 times more common with formula only. Early feeding with the mother's own milk was associated with a lower risk of severe NEC in the English national data (Battersby 2017). Oropharyngeal colostrum (placing a small amount of the mother's colostrum on the inside of the cheek in the first days of life) has been studied: a Cochrane review of six small trials (335 infants) found no significant difference in NEC, late-onset infection or death, with very low-quality evidence, and called for larger trials (Nasuf 2018).

When a mother's own milk is not available, the alternatives are pasteurized donor human milk or formula. The 2024 Cochrane review by Quigley and colleagues (12 trials, 2,296 infants) found with high certainty that donor human milk reduces the risk of NEC by about half compared with formula in very preterm or VLBW infants (risk ratio 0.53), with probably little or no effect on late-onset infection or all-cause mortality before discharge (Quigley 2024).

Probiotics

Probiotics — enterally given products containing live bacteria or yeast — have been tested in many randomized trials. The 2011 Cochrane review by Alfaleh and colleagues analyzed 16 trials (2,842 infants) and found that enteral probiotics reduced severe NEC (Stage II or more) and all-cause mortality in preterm infants (Alfaleh 2011). The 2023 update of that review (60 trials, 11,156 infants) found that probiotics may reduce NEC in very preterm or VLBW infants (risk ratio 0.54; low certainty) and probably reduce mortality slightly (risk ratio 0.77; moderate certainty); in extremely preterm or extremely low birth weight infants, probiotics may have little or no effect on NEC or mortality. The preparations varied, most often containing Bifidobacterium, Lactobacillus, Saccharomyces and Streptococcus species alone or in combination, and the authors called for further large, high-quality trials (Sharif 2023).

In the United States, the American Academy of Pediatrics' 2021 clinical report noted that probiotic products are sold as dietary supplements without FDA-approved drug labeling, that large meta-analyses show efficacy of multiple-strain probiotics in reducing NEC and mortality while single-strain efficacy is less certain, and that some supplement-grade products have been recalled for contamination. It concluded that, given the lack of FDA-regulated pharmaceutical-grade products, conflicting safety and efficacy data and potential for harm, current evidence does not support routine, universal administration of probiotics to preterm infants, particularly those under 1,000 g (Poindexter 2021). On October 26, 2023, the FDA warned of the risks probiotic products pose to preterm infants in hospitals: infants given a probiotic product are at risk of invasive, potentially fatal disease or infection caused by the bacteria or yeast in the product; the agency reported one infant death in 2023 and more than two dozen other adverse events reported in the United States since 2018, stated that it has not approved any probiotic product for use as a drug or biological product in infants of any age, and issued warning letters to two companies (FDA, October 26, 2023). A 2011 review had earlier noted a higher incidence of sepsis among infants receiving probiotics in one trial, especially below 750 g (Neu and Walker 2011).

Antenatal Corticosteroids

Corticosteroids given to women at risk of preterm birth reduce perinatal death, neonatal death and respiratory distress syndrome and probably reduce intraventricular haemorrhage, according to the 2020 Cochrane review of 27 trials; NEC is not among the outcomes reported in that review's abstract (McGoldrick 2020).

Standardized Feeding Protocols

A 2017 meta-analysis of 15 observational before-and-after studies (18,160 infants) found that introducing a standardized feeding regimen was associated with a lower incidence of NEC (risk ratio 0.22) (Jasani and Patole 2017). The speed of advancing feeds is a separate question: the 2021 Cochrane review of 14 randomized trials (4,033 infants) found that slow advancement (daily increments up to 24 mL/kg) probably does not reduce NEC or death compared with faster advancement and may slightly increase invasive infection (Oddie 2021).

Caffeine

In the Caffeine for Apnea of Prematurity (CAP) trial, which randomized 2,006 infants weighing 500 to 1,250 g, caffeine reduced bronchopulmonary dysplasia, but the rates of death, brain injury on ultrasound, and NEC did not differ significantly between the caffeine and placebo groups (Schmidt 2006).

Transfusion Practices

In the 2012 meta-analysis, two small before-and-after studies (20 patients in total) reported fewer transfusion-associated NEC cases after feeds were withheld during transfusion (Mohamed and Shah 2012). Whether this practice prevents NEC has not been established in randomized trials, and later prospective data link NEC to severe anemia rather than to transfusion itself (Patel 2016).

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Long-Term Outcomes for Families

Families of babies who have had NEC face both real long-term challenges and real grounds for hope. Outcomes differ most sharply between infants managed medically and those who needed surgery.

Medical NEC

In a study of 2,948 extremely low birth weight infants assessed at 18 to 22 months' corrected age, medically managed NEC did not seem to add neurodevelopmental or growth risk compared with infants without NEC (Hintz 2005). Post-NEC intestinal strictures and recurrent NEC are recognized complications studied as outcomes after NEC (Patel 2020).

Surgical NEC: GI and Growth Complications

Neurodevelopmental Outcomes

NEC is associated with worse neurodevelopmental outcome than prematurity alone. A 2007 meta-analysis of 7,843 children (821 with NEC) found that 45% of children who had neonatal NEC were neurodevelopmentally impaired; infants with NEC were more likely than infants of similar age and gestation without NEC to be impaired (odds ratio 1.6), including higher risks of cerebral palsy (1.5) and visual and psychomotor impairment, and the odds were 2.3 times higher with Bell's stage III disease or surgery (Rees 2007). In the NICHD Neonatal Research Network study of extremely low birth weight infants, surgically managed NEC — but not medically managed NEC — was an independent risk factor for neurodevelopmental impairment (odds ratio 1.78) (Hintz 2005). One review describes an infant recovering from NEC as having nearly a 25% chance of microcephaly and serious neurodevelopmental delays (Neu and Walker 2011).

Studies such as these assess development at follow-up visits, commonly at 18 to 22 months' corrected age (Hintz 2005; Blakely 2021).

Grief, Trauma, and Support

For families whose babies do not survive NEC, grief is profound. Even when babies survive, the NICU experience itself can be traumatic for parents: a 2023 systematic review of seven studies reported posttraumatic stress symptoms in 4.5–30% of mothers and 0–33% of fathers of infants admitted to the NICU, indicating that up to one-third of parents may be affected (McKeown 2023). NICU social workers, bereavement programs and peer communities of families who have lived through NEC are among the sources of support available.

The NEC Society (necsociety.org) describes itself as a nonprofit organization led by families, clinicians and scientists, launched in 2014, that works on NEC research, education and advocacy and offers resources for recently diagnosed and bereaved families.

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Key Research Papers

  1. Neu J, Walker WA (2011). Necrotizing enterocolitis. N Engl J Med 364(3):255-64 — PubMed PMID: 21247316
  2. Lin PW, Stoll BJ (2006). Necrotising enterocolitis. Lancet 368(9543):1271-83 — PubMed PMID: 17027734
  3. Quigley M, Embleton ND, Meader N, McGuire W (2024). Donor human milk for preventing necrotising enterocolitis in very preterm or very low-birthweight infants. Cochrane Database Syst Rev 9:CD002971 — PubMed PMID: 39239939 (2024 update of the Quigley and McGuire review first published as "Formula versus donor breast milk")
  4. Alfaleh K, Anabrees J, Bassler D, Al-Kharfi T (2011). Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev (3):CD005496 — PubMed PMID: 21412889 (superseded by later updates; see Sharif 2023 below)
  5. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, et al. (2005). Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 115(3):696-703 — PubMed PMID: 15741374
  6. Rees CM, Pierro A, Eaton S (2007). Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 92(3):F193-8 — PubMed PMID: 16984980
  7. Gephart SM, Gordon PV, Penn AH, Gregory KE, Swanson JR, Maheshwari A, et al. (2018). Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell's stages and biomarkers for NEC. Semin Pediatr Surg 27(1):3-10 — PubMed PMID: 29275814
  8. Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK, et al. (2006). Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics 117(4):e680-7 — PubMed PMID: 16549503
  9. Lucas A, Cole TJ (1990). Breast milk and neonatal necrotising enterocolitis. Lancet 336(8730):1519-23 — PubMed PMID: 1979363
  10. Sharma R, Kraemer DF, Torrazza RM, Mai V, Neu J, Shuster JJ, et al. (2014). Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. J Perinatol 34(11):858-62 — PubMed PMID: 25144159
  11. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. (1978). Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 187(1):1-7 — PubMed PMID: 413500
  12. Obladen M (2009). Necrotizing enterocolitis—150 years of fruitless search for the cause. Neonatology 96(4):203-10 — PubMed PMID: 19407465
  13. Sharif S, Meader N, Oddie SJ, Rojas-Reyes MX, McGuire W (2023). Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants. Cochrane Database Syst Rev 7:CD005496 — PubMed PMID: 37493095
  14. Poindexter B; Committee on Fetus and Newborn (2021). Use of probiotics in preterm infants. Pediatrics 147(6):e2021051485 — PubMed PMID: 34031231
  15. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, et al. (2006). Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 354(21):2225-34 — PubMed PMID: 16723614
  16. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A (2008). Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg 248(1):44-51 — PubMed PMID: 18580206
  17. Blakely ML, Tyson JE, Lally KP, Hintz SR, Eggleston B, Stevenson DK, et al. (2021). Initial laparotomy versus peritoneal drainage in extremely low birthweight infants with surgical necrotizing enterocolitis or isolated intestinal perforation: a multicenter randomized clinical trial. Ann Surg 274(4):e370-e380 — PubMed PMID: 34506326
  18. Mohamed A, Shah PS (2012). Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics 129(3):529-40 — PubMed PMID: 22351894
  19. Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, et al. (2016). Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants. JAMA 315(9):889-97 — PubMed PMID: 26934258
  20. Schmidt B, Roberts RS, Davis P, Doyle LW, Barrington KJ, Ohlsson A, et al. (2006). Caffeine therapy for apnea of prematurity. N Engl J Med 354(20):2112-21 — PubMed PMID: 16707748
  21. Oddie SJ, Young L, McGuire W (2021). Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 8:CD001241 — PubMed PMID: 34427330
  22. Jasani B, Patole S (2017). Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol 37(7):827-833 — PubMed PMID: 28358382
  23. Nasuf AWA, Ojha S, Dorling J (2018). Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 9:CD011921 — PubMed PMID: 30191961
  24. Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sánchez PJ, et al. (2009). Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 123(1):58-66 — PubMed PMID: 19117861
  25. McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW, et al. (2000). Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106(5):1080-7 — PubMed PMID: 11061778
  26. Kamoji VM, Dorling JS, Manktelow B, Draper ES, Field DJ (2008). Antenatal umbilical Doppler abnormalities: an independent risk factor for early onset neonatal necrotizing enterocolitis in premature infants. Acta Paediatr 97(3):327-31 — PubMed PMID: 18298781
  27. Alsaied A, Islam N, Thalib L (2020). Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis. BMC Pediatr 20(1):344 — PubMed PMID: 32660457
  28. Battersby C, Longford N, Mandalia S, Costeloe K, Modi N; UK Neonatal Collaborative Necrotising Enterocolitis (UKNC-NEC) study group (2017). Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study. Lancet Gastroenterol Hepatol 2(1):43-51 — PubMed PMID: 28404014
  29. Shah D, Sinn JK (2012). Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis. Cochrane Database Syst Rev (8):CD007448 — PubMed PMID: 22895960
  30. Cuna AC, Lee JC, Robinson AL, Allen NH, Foley JE, Chan SS (2018). Bowel ultrasound for the diagnosis of necrotizing enterocolitis: a meta-analysis. Ultrasound Q 34(3):113-118 — PubMed PMID: 29369246
  31. Coit AK (1999). Necrotizing enterocolitis. J Perinat Neonatal Nurs 12(4):53-66 — PubMed PMID: 10373856
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  35. McKeown L, Burke K, Cobham VE, Kimball H, Foxcroft K, Callaway L (2023). The prevalence of PTSD of mothers and fathers of high-risk infants admitted to NICU: a systematic review. Clin Child Fam Psychol Rev 26(1):33-49 — PubMed PMID: 36564614

PubMed Topic Searches

  1. PubMed: Necrotizing enterocolitis preterm infant prevention
  2. PubMed: Necrotizing enterocolitis human breast milk donor
  3. PubMed: Probiotics necrotizing enterocolitis randomized trial
  4. PubMed: NEC surgery short bowel syndrome neonatal
  5. PubMed: Necrotizing enterocolitis neurodevelopment outcome
  6. PubMed: Bell staging criteria NEC systematic review

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Connections

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