Necrotizing Enterocolitis: A Misnomer – How do we fix it? (209)

What is termed necrotizing enterocolitis “NEC” in neonates is an overly broad, highly ambiguous diagnosis. It is commonly called a “disease”, but this implies a distinct and measurable condition with a clear cause. “NEC” encompasses several forms of intestinal injury and dysfunction with poorly understood pathophysiologic mechanisms. Examples include spontaneous intestinal perforations, food protein intolerance, congenital anomalies of the GI tract and cardiogenic intestinal ischemia. Most infants diagnosed with “NEC” have no evidence of intestinal necrosis, hence, the term is a misnomer. Recent studies have emphasized artificial intelligence (AI) and “omic” technologies to elucidate the pathophysiology of “NEC”. For example, certain bacterial taxa are different in those infants subsequently developing “NEC” compared to controls. These have provided associations but not causal mechanisms. They have also not provided clear preventative strategies largely because of the assumption that “NEC” is a single disease. Specific biomarkers have not been identified for the same reason. If the field of neonatology continues its attempt to find a single pathophysiology for “NEC”, it will fail. Elucidation of mechanisms and predictive biomarkers from newly derived taxonomic clusters of intestinal injury in preterm neonates will lead to targeted diagnostic, preventative, and therapeutic strategies.