The Pathophysiology of Necrotizing Enterocolitis

Introduction Despite many years of clinical observation and experimental investigation, the pathogenesis of neonatal enterocolitis (NEC) remains elusive. The multifactorial theory suggests that four key risk factors—prematurity, formula feeding, intestinal ischemia, and bacterial colonization—are important prerequisites to the initiation of intestinal injury in neonates (Figure). Current hypotheses suggest that these risk factors stimulate activation of the inflammatory cascade that ultimately results in the final common pathway of bowel necrosis that is the hallmark of neonatal NEC.