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Children
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Necrotizing Enterocolitis in Newborns
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Necrotizing Enterocolitis in Newborns

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: 15 October 2026 | Viewed by 2540

Editors

Dr. Chandra Prakash Rath

E-Mail Website
Guest Editor
1. Neonatology, Canberra Hospital, Canberra, ACT 2605, Australia
2. School of Medicine, University of Western Australia, Perth, WA 6009, Australia
Interests: necrotizing enterocolitis; premature infants; risk factors; neonatal outcomes
Prof. Dr. Sanjay Patole

E-Mail Website
Guest Editor
1. Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia
2. School of Medicine, University of Western Australia, Perth, WA 6009, Australia
Interests: necrotizing enterocolitis; premature infants; risk factors; neonatal outcomes

Special Issue Information

Dear Colleagues,

Despite decades of research, necrotizing enterocolitis (NEC) continues to be a devastating illness, particularly in extremely preterm infants. Our inability to prevent preterm birth, the single most important risk factor for the illness, means that the elimination of NEC will continue to be a difficult task. Furthermore, the poorly understood pathogenesis of NEC has made it difficult to develop effective strategies for the treatment of established disease.

Considering the significant mortality, morbidity, including long-term neurodevelopmental impairment, and suffering that it causes, NEC has been a research priority for decades. Many well-known experts in this field have come together to share their expertise in this Special Issue of Children dedicated to NEC, known as a disease with no cure. Their contributions are expected to guide research and clinical practice in the prevention, diagnosis, and management of NEC in preterm infants.

Dr. Chandra Prakash Rath
Prof. Dr. Sanjay Patole
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • necrotizing enterocolitis
  • premature infant
  • pathophysiology
  • treatment
  • risk factors
  • neonatal outcome

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Published Papers (3 papers)

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Review

22 pages, 1177 KB  
Review
Biomarkers for Necrotising Enterocolitis—Are We There Yet?
by Anna Jackson, Maria Cifuentes Nino and Janet Berrington
Children 2026, 13(7), 894; https://doi.org/10.3390/children13070894 - 3 Jul 2026
Abstract
Necrotising enterocolitis (NEC) remains an important disease for neonatologists, with diagnostic and management challenges and impacts on mortality and neurodisability. NEC can present in a non-specific way, and differentiating from late-onset sepsis (LOS), focal perforation (FIP) and feed intolerance can be difficult. Biomarkers [...] Read more.
Necrotising enterocolitis (NEC) remains an important disease for neonatologists, with diagnostic and management challenges and impacts on mortality and neurodisability. NEC can present in a non-specific way, and differentiating from late-onset sepsis (LOS), focal perforation (FIP) and feed intolerance can be difficult. Biomarkers have been extensively explored as a way to help more definitively identify NEC or rule it out. Many biomarkers that have been studied are blood biomarkers, and several other extensive reviews of biomarkers in NEC exist. In this narrative review, we focus on non-invasive samples, namely stool, urine and saliva, and on tests that are already available as point-of-care tests (POCTs) or are likely to be available as POCTs soon given current technologies. Faecal calprotectin and urinary intestinal fatty acid-binding protein (IFABP) have the most data to currently support their use in larger multi-centre studies and appear most likely to achieve translation into clinical practice. Saliva appears the most under-researched potential source of a non-invasive POCT for a biomarker for NEC. For faecal calprotectin and urinary IFABP, data that are most lacking relate to specificity, particularly the performance of these tests to differentiate NEC from FIP or LOS (occurring in the absence of NEC). We suggest a study design to facilitate moving towards the clinical use of non-invasive biomarkers in NEC. Full article
(This article belongs to the Special Issue Necrotizing Enterocolitis in Newborns)
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Graphical abstract

22 pages, 8658 KB  
Review
Imaging and Non-Imaging Approaches for the Diagnosis and Monitoring of Necrotizing Enterocolitis—What Lies Ahead?
by Indrani Bhattacharjee, Catalina Le Cacheux, Eric B. Ortigoza, Jonathan Dillman, Sherwin S. Chan and Alain Cuna
Children 2026, 13(6), 787; https://doi.org/10.3390/children13060787 - 5 Jun 2026
Viewed by 390
Abstract
Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. [...] Read more.
Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely. Full article
(This article belongs to the Special Issue Necrotizing Enterocolitis in Newborns)
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17 pages, 1323 KB  
Review
Diagnosis and Staging of Necrotizing Enterocolitis: Current Controversies and a Phenotype-Based Framework
by Usha Devi, Jörn-Hendrik Weitkamp, Jeffrey S. Shenberger and Parvesh Mohan Garg
Children 2026, 13(6), 758; https://doi.org/10.3390/children13060758 - 29 May 2026
Viewed by 1424
Abstract
Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonates and also presents major diagnostic challenges. Despite extensive research, NEC still lacks a practical definition and relies on a set of nonspecific clinical, laboratory, and radiological findings rather than a [...] Read more.
Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonates and also presents major diagnostic challenges. Despite extensive research, NEC still lacks a practical definition and relies on a set of nonspecific clinical, laboratory, and radiological findings rather than a single pathognomonic presentation or test. The modified Bell staging system remains the most widely used framework in clinical practice and research, but it was originally developed to guide treatment decisions rather than aid diagnosis and has important limitations when applied as a diagnostic aid. Clinical and radiological criteria used for early stages of NEC are nonspecific, disease progression is not always linear, radiographic signs are inconsistently present, and histopathological confirmation is unavailable in most of the cases as surgery is not undertaken in all the cases. These limitations have led to the opinion that even the modified Bell staging is “broken” when it is used to define the disease itself. At the same time, increased understanding about gut immunity and microbiome progression, and neonatal hemodynamics make it increasingly clear that NEC is not a single uniform disease. It is now regarded as a heterogeneous syndrome comprising multiple phenotypes that share a final common pathway of intestinal injury and necrosis differing in timing, predisposing factors, mechanism, and clinical course. These presentations overlap with several neonatal conditions including spontaneous intestinal perforation, septic ileus, cow’s milk protein allergy, congenital heart disease-related intestinal hypoperfusion, viral enterocolitis, malrotation with volvulus, and intussusception. This review discusses controversies in the definition and staging of NEC, consolidates alternative diagnostic criteria beyond Bell’s system, and elaborates on a phenotype-based framework for clinical distinction. Also, the review sheds light on the clinical mimickers, practical bedside diagnosis using serial clinical assessment and imaging, consequences of NEC, and emerging precision medicine approaches. A shift from stage-based labeling toward a practical, phenotype-informed framework may improve diagnostic precision, reduce misclassification, and enhance both clinical care and research. Full article
(This article belongs to the Special Issue Necrotizing Enterocolitis in Newborns)
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