Preventing necrotizing enterocolitis in very low birth weight infants: current evidence

Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal disorder affecting very preterm or very low birth weight infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. Postnatally, a variety of practices have been implicated in the pathogenesis of NEC including formula milk feeding, early and rapid advancement of enteral feed volumes, and exposure to H2-receptor antagonists. NEC, particularly severe NEC requiring surgical intervention, is associated with acute morbidity and mortality, prolonged hospital stay, and adverse long-term neuro-developmental outcomes. With the exception of feeding with human milk, only limited evidence is currently available to support interventions to prevent NEC. Promising strategies that merit further evaluation in randomized controlled trials include the use of standardized feeding protocols and immuno-prophylaxis with prebiotics and probiotics.