Tullie, Lucinda; Eaton, Simon; Blackburn, Simon; (2025) Necrotizing enterocolitis. Surgery (United Kingdom) 10.1016/j.mpsur.2025.10.006. (In press).

Text Eaton_NEC article LT SB SE v2.1.pdf Access restricted to UCL open access staff until 30 October 2026. Download (525kB)

Abstract

Necrotizing enterocolitis (NEC) is a gastrointestinal emergency which predominantly affects low-birth-weight, premature infants and is a significant cause of morbidity and mortality. Whilst its aetiology is not fully understood, NEC is believed to arise in infants with an altered microbiome and immature intestinal epithelium susceptible to inflammation after exposure to enteral feeds. This leads to the characteristic features of NEC: infection, inflammation and subsequent intestinal ischaemia. Several factors, including breast milk, are protective and ameliorate this process. The majority of infants with mild NEC respond to supportive management with antibiotics and gut rest. Surgical management is undertaken for bowel perforation and in infants who have progressive disease or who fail conservative management. With the exception of bowel perforation, deciding both upon which infants need surgery, and when surgery is undertaken, is a major challenge in NEC. The aim of surgery is to resect necrotic bowel whilst preserving gut length. Despite extensive research, NEC outcomes remain poor with significant mortality of up to 50% in very low-birth-weight infants and morbidity including neurodevelopmental delay and intestinal failure.

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