An update on the management of necrotizing enterocolitis: Surgical perspective

Necrotizing enterocolitis (NEC) is the most common of neonatal surgical emergency. The initial signs are nonspecific and often indistinguishable from other neonatal problems. Abdominal radiography (AR) is the first modality imaging for diagnosis NEC and remains as the standard modality since the Bell staging system was developed. Ultrasonography (US) playing an increasing role in NEC. There is the potential for US to bridge the lack of sensitivity of AR for NEC. Understanding the influence of the pathophysiological dynamic of NEC and its variation with gestational age on AR or US findings is important to distinguish NEC from NEC-like conditions. Surgical NEC consisting of laparotomy and/or defunctionalize bowel and peritoneal drainage in unstable patients. The options are determined by hemodynamics, comorbidities and extend of the disease. There is wide variation in practice patterns across surgeons and institutions. Future guidelines should focus on evidence-based support for individualized decisions rather than uniform protocols to fit all.