Necrotizing Enterocolitis in Preterm Infants is Related to Enteral Feeding, But the Mechanisms Remain Uncertain and Have Changed Over Time

Abstract

Although the pathophysiology of necrotizing enterocolitis (NEC) remains incompletely understood, recent evidence supports the important role of aberrant bacterial colonization and activated pro-inflammatory signaling in the high-risk premature infant (Neu and Walker, N Engl J Med 364:255–264, 2011). Nonetheless, most clinicians surmise that enteral feeding significantly contributes to the initiation of intestinal injury in NEC, and multiple studies have provided insight into the impact of feeding on intestinal health and homeostasis (Meinzen-Derr et al., J Perinatol 29:57–62, 2009). In this report, the impact of feeding on NEC will be reviewed, and it is suggested that enteral feedings can have a protective role in the disease, while conversely in other situations, enteral feedings might initiate changes contributing to this devastating condition. It is concluded that our understanding of enteral feeding and NEC has changed over time, and new insights continue to provide clues to the pathogenesis of this challenging condition.