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Necrotizing Enterocolitis Risk: State of the Science

Gephart, Sheila M. RN, BSN; McGrath, Jacqueline M. PhD, RN; Effken, Judith A. PhD, RN; Halpern, Melissa D. PhD

Section Editor(s): Ikuta, Linda

doi: 10.1097/ANC.0b013e31824cee94
Foundations in Newborn Care

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.

College of Nursing (Ms Gephart and Dr Effken) and Steele Children's Research Center (Dr Halpern), University of Arizona, Tucson; and School of Nursing, Virginia Commonwealth University, Richmond (Dr McGrath).

Correspondence: Sheila M. Gephart, RN, BSN, College of Nursing, University of Arizona, PO Box 210203, Tucson, AZ 85721 (

The project described was supported by grant number F31NR012333 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

The authors declare no conflict of interest.

© 2012 National Association of Neonatal Nurses