Necrotizing Enterocolitis in Preterm Infants
Keywords:
Necrotizing enterocolitis, preterm infants, prematurity, very low birth weight, neonatal intensive care, intestinal inflammation, human milk, neonatal morbidity, intestinal microbiota, neonatal surgeryAbstract
Necrotizing enterocolitis (NEC) is one of the most serious gastrointestinal emergencies affecting preterm infants, particularly those born at very low birth weight. It is characterized by intestinal inflammation and varying degrees of intestinal wall injury, which may progress to necrosis, perforation, systemic infection, and multiorgan dysfunction. Despite advances in neonatal intensive care, NEC remains an important cause of morbidity and mortality among premature newborns. Its pathogenesis is multifactorial and involves intestinal immaturity, dysregulated immune responses, alterations in the gut microbiota, impaired intestinal barrier function, and feeding-related factors. Established risk factors include extreme prematurity, low birth weight, formula feeding, and compromised intestinal perfusion. Early recognition is essential because the initial clinical manifestations, including feeding intolerance, abdominal distension, vomiting, bloody stools, apnea, and temperature instability, may be nonspecific. Diagnosis is based on clinical assessment, laboratory investigations, and imaging, particularly abdominal radiography and, where available, intestinal ultrasonography. Management depends on disease severity and generally includes cessation of enteral feeding, gastric decompression, intravenous fluid and nutritional support, antimicrobial therapy, and close monitoring. Surgical intervention may be necessary in cases of intestinal perforation, necrosis, or clinical deterioration despite intensive medical treatment. Human milk feeding, standardized feeding protocols, infection prevention, and careful monitoring of high-risk infants are important preventive strategies. This review summarizes the current understanding of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnosis, treatment, and prevention of necrotizing enterocolitis in preterm infants.
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