Necrotizing enterocolitis is a medical condition in which necrosis in various parts of bowel takes place. Usually it affects the premature infants and causes abdominal distension, intestinal necrosis and hemorrhage. In necrotizing enterocolitis, the primary risk factor is prematurity and it is the major cause of morbidity and mortality among the newborn babies. Particularly the infants having very low birth weight are more susceptible to NEC. The way of management of infants with NEC is quite different from other neonates. So any infant with symptoms of NEC, needs immediate treatment otherwise it may lead to some severe conditions of this disease. However, prevention is best cure of it because NEC has multifactorial nature in its etiology.

Necrotizing enterocolitis is a disease of GIT track in which various portions of the bowel undergo necrosis and ultimately cause tissue damage [1]. This disease most probably occurs in premature infants that having no any other disease. Out of one thousand infants, about 2 or 3 are affected by this disease. Treatment of infants with NEC mostly involves bowel rest, gastric decompression, systemic antibiotics and parenteral nutrition. However, prevention from preterm birth and avoidance from milk of donor give great potential benefits [2,3]. The incidence of NEC varies inversely with pregnancy period length, mostly occurs in those infants with less gestational age.

Etiology
Definite cause of necrotizing enterocolitis is still unknown. However, Pseuodomonas aeruginosa is suspected to be a cause of this disease in infants [4-6]. Many other causes of necrotizing enterocolitis include poor immune system, intestinal flora, prolonged use of antibiotics and oral feeding other than the breast milk of the mother. It is proposed that oral feeding in infants increases the risk of necrotizing enterocolitis ten times greater than the infants that having feed from the mother directly. [7,8] Its reason is that the breast milk of the mother has anti-infective property that prevents the infants against certain diseases. [9]

Pathophysiology
As the causative agent of necrotizing enterocolitis is not confirmed, so, its pathogenesis is also not exactly known. [10-12] However,

1. Infants those having intestinal flora like Staphylococcus aureus and E. coli are more susceptible to NEC.
2. Long term antibiotic therapy causes the change in the internal environment of the GIT that may lead to necrosis.
3. Immature intestinal mucosa may also the cause of NEC.

Sign and Symptoms
Initial symptoms are feeding disturbance, bloody stools due to mucosal damage and abdominal distension. Late symptoms are perforations in the various parts of GIT, peritonitis and hypotension [13,14].

Diagnosis
Necrotizing enterocolitis is diagnosed clinically but it also requires certain imaging techniques to confirm the disease like radiography, ultrasonography, etc. radiographic signs in infant having NEC are expansion of bowel loop (due to filling of gas) and pneumoperitoneum (free air outside the bowel within the abdomen) [15,16]. Ultrasonography also proves an effective technique in the diagnosis of NEC. Mostly abdominal distension, intestinal necrosis and hemorrhage like symptoms are seen in case of necrotizing enterocolitis in infants [17].

Treatment
Surgical treatment of NEC is possible but it may cause certain complications like short bowel syndrome and suppression in neural development. During surgery dead bowel contents are removed from the body [18-20]. Rather than the treatment, preventive measures are very useful to minimize the risk of NEC. Prevention is the best cure of NEC because there is many causes of getting NEC in infants, in other words NEC has multifactorial nature regarding its etiology [21,22].

Prevention
These include

1. Minimize oral feeding.
2. Stoppage of antibiotic therapy
3. Use only human milk or milk from donor if mother's milk is unavailable.
4. Recent study shows that the use of higher rate of lipid infusion in the first week of life resulted in no infant with NEC [23].