NECROTIZING ENTEROCOLITIS IN PRETERM INFANTS: PATHOGENESIS, EARLY DIAGNOSIS, SURGICAL MANAGEMENT, AND PREVENTION

Necrotizing enterocolitis (NEC) is one of the most serious gastrointestinal emergencies affecting premature and very-low-birth-weight infants. It is characterized by intestinal inflammation and varying degrees of intestinal ischemia, necrosis, and, in severe cases, intestinal perforation. NEC remains an important cause of morbidity and mortality in neonatal intensive care units, particularly among extremely premature infants. Its pathogenesis is multifactorial and involves immature intestinal barrier function, abnormal intestinal microbiota, dysregulated inflammatory responses, impaired intestinal perfusion, and interactions with enteral nutrition. Clinical manifestations range from feeding intolerance and abdominal distension to systemic instability, metabolic acidosis, hypotension, intestinal perforation, and septic shock. Early diagnosis requires careful clinical observation combined with laboratory assessment and abdominal imaging. Abdominal radiography remains an important diagnostic method, while ultrasonography is increasingly used for assessment of bowel wall perfusion, thickness, peristalsis, and free fluid. Management depends on disease severity and includes bowel rest, gastric decompression, intravenous fluids, nutritional support, antimicrobial therapy, respiratory and cardiovascular stabilization, and close monitoring. Surgical intervention is indicated in intestinal perforation and selected cases of progressive or severe disease. Surgical strategies include peritoneal drainage and laparotomy with resection of necrotic bowel. Prevention focuses on human milk feeding, standardized feeding protocols, avoidance of unnecessary antibiotic exposure, optimization of perinatal care, and prevention of prematurity. Advances in neonatal intensive care, microbiome research, biomarkers, intestinal ultrasonography, and precision medicine may improve early diagnosis and outcomes in the future.