The complex interaction of enteral feeding in the pathogenesis of necrotizing enterocolitis.

NEC is a multifactorial gastrointestinal disorder affecting medically fragile infants in the neonatal intensive care unit (NICU) and is associated with significant morbidity and mortality. Although the precise pathogenesis of NEC is not well understood, prematurity remains a significant risk factor. Immature intestinal immunity, altered microbial colonization (dysbiosis), and dysregulated inflammatory responses contribute to NEC susceptibility in the preterm intestine.1 During NEC, an exaggerated inflammatory response can lead to intestinal tissue damage and in severe cases, surgical resection of necrotic bowel may be required. NEC affects 5-7% of very low birth weight (VLBW) infants according to large-scale estimates of >500,000 infants.2 In addition to biologic vulnerability related to prematurity, epidemiologic studies have identified associations between NEC and maternal health, racial and ethnic disparities, and socioeconomic factors.3-7 Herein we discuss the complex relationship between enteral feeding and NEC, focused on the complex relationships between environment, nutrient composition, and feeding practices on disease susceptibility.