Introduction and historical aspects and where may we be going in the future: getting rid of necrotizing enterocolitis

: The precise pathophysiology, prevention and treatment of what is commonly diagnosed as necrotizing enterocolitis (NEC) disease has been elusive. This bears at least partial responsibility for lack of progress in preventative strategies. A clear unambiguous definition that represents a discrete disease is not currently available and likely is a major component of difficulties with understanding a discrete pathophysiology. It is thus becoming increasingly clear that our current paradigm of NEC as a distinct disease is incorrect and the ambiguity in what is being referred to as NEC may be a reason for our lack of progress in prevention. Because of this, we need to critically review our current concepts, how they have evolved in the past several decades and determine how we can best re-evaluate intestinal injuries and dysfunctions that are currently being called NEC. In this review, we discuss historical aspects of NEC as well as our current concepts and a potential pathway using newly developed artificial intelligence/machine learning (AI/ML) and multiomic integrations for a paradigm shift that will alter our strategies for early prediction, diagnostics, prevention, and treatment of the various forms of intestinal injury and dysfunction currently referred to as NEC. This will represent a major challenge but is critical if we are to make progress.