The contribution of the antenatal period in the development of necrotising enterocolitis.

Necrotising enterocolitis (NEC) is a disorder characterised by intestinal ischaemia and inflammation. It predominantly impacts preterm and low birthweight infants and carries a high burden of mortality and both short and long-term morbidity for survivors. Postnatal factors such as abnormal bacterial colonisation of the gut (dysbiosis) and formula feeding are known to predispose to the development of NEC. The contribution of the antenatal period to the subsequent development of NEC is poorly understood. Although it is known that fetuses with growth restriction, particularly those with abnormal blood flow in the umbilical cord (absent or reversed end diastolic flow), are at increased risk, these alterations are not a prerequisite for its development. Predictive tests in other high-risk groups, such as fetuses who go on to deliver spontaneously preterm, are even more limited. The difficulties in prognosticating the risk of NEC during the antenatal period are compounded by the aetiology not yet being fully elucidated and being multifactorial. This review examines current evidence on how antenatal factors contribute to the development of necrotising enterocolitis.