NECROTIZING ENTEROCOLITIS: FROM PATHOPHYSIOLOGY TO MODERN PREVENTION AND EARLY DIAGNOSTIC STRATEGIES

Martyna Sowa; Paulina Makowska; Alicja Laske; Natalia Sitko; Joanna Gontarczyk; Antoni Majda; Julia Pająk; Kacper Kucharski; Anna Kamosińska; Adam Kowal; Julia Sokołowska; Marcel Dawidowicz

doi:10.31435/ijitss.1(49).2026.5400

Authors

Martyna Sowa Independent Public Healthcare Facility in Bochnia “District Hospital”, Bochnia, Poland https://orcid.org/0009-0003-7152-5787
Paulina Makowska Voivodeship Specialist Hospital in Wrocław, Wrocław, Poland https://orcid.org/0009-0009-1279-5422
Alicja Laske 4th Military Clinical Hospital with Polyclinic, Independent Public Health Care Centre, Wrocław, Poland https://orcid.org/0009-0000-3690-4659
Natalia Sitko Lower Silesian Specialist Hospital T. Marciniak - Emergency Medicine Centre, Wrocław, Poland https://orcid.org/0009-0002-4128-134X
Joanna Gontarczyk University Hospital in Wrocław, Wrocław, Poland https://orcid.org/0009-0002-7512-8853
Antoni Majda Provincial Specialist Hospital in Wroclaw, Wroclaw, Poland https://orcid.org/0009-0006-4357-513X
Julia Pająk 4th Military Clinical Hospital with Polyclinic, Independent Care Institution, Wroclaw, Poland https://orcid.org/0009-0007-0882-9365
Kacper Kucharski Jan Mikulicz Radecki University Clinical Hospital, Wroclaw, Poland https://orcid.org/0009-0004-5709-8974
Anna Kamosińska 4th Military Clinical Hospital with Polyclinic, Independent Care Institution, Wroclaw, Poland https://orcid.org/0009-0005-0718-2112
Adam Kowal Jan Mikulicz Radecki University Clinical Hospital, Wroclaw, Poland https://orcid.org/0009-0007-7779-598X
Julia Sokołowska Lower Silesian Centre for Oncology, Pulmonology and Hematology, Wrocław, Poland https://orcid.org/0000-0002-7042-0348
Marcel Dawidowicz Lower Silesian Centre for Oncology, Pulmonology and Hematology, Wrocław, Poland https://orcid.org/0009-0000-5297-3507

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5400

Keywords:

Necrotizing Enterocolitis, Preterm Infants, Gut Dysbiosis, Biomarkers, Abdominal Ultrasound, Human Milk, Human Milk Oligosaccharides (HMOs), Probiotics, Standardized Feeding Protocols

Abstract

Background: Necrotizing enterocolitis (NEC) is a severe, multifactorial inflammatory disease and a leading cause of gastrointestinal mortality in preterm infants, particularly those with very low birth weight. Despite advances in neonatal care, its pathogenesis, early diagnosis, and effective prevention remain significant clinical challenges.

Objective: This review aims to synthesize current knowledge (2018–2026) on the pathophysiology, diagnostic strategies, and preventive interventions in NEC, with a focus on improving early detection and clinical outcomes.

Methodology: A narrative review of recent scientific literature was conducted, analyzing studies on molecular mechanisms, including immune dysregulation and gut microbiota, as well as advances in diagnostic tools and nutritional prevention strategies.

Results: Contemporary evidence indicates that NEC arises from an exaggerated immune response mediated by Toll-like receptor 4 (TLR4) in the immature intestine, compounded by gut dysbiosis and hypoxic factors, as described in the “two-hit” hypothesis. Diagnostic approaches are shifting from reliance on the Bell classification toward multi-modal strategies integrating abdominal ultrasound and biomarkers such as C-reactive protein. Preventive measures, particularly the use of human milk, human milk oligosaccharides, probiotics, and standardized feeding protocols, significantly reduce disease incidence and severity.

Conclusions: NEC management is evolving toward a proactive, precision-based model that integrates early diagnosis with targeted nutritional and microbiome-based interventions. These strategies offer substantial potential to reduce mortality and long term complications in this vulnerable population.

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