The fifty billion dollar question: does formula cause necrotizing enterocolitis?

The question of whether preterm infant formulas cause necrotizing enterocolitis (NEC) is the subject of multiple lawsuits and has daily relevance in the care of preterm infants. Research supporting the hypothesis that toxic components in infant formula cause NEC is limited to preclinical data while data from human infants are lacking. Human milk should be the first choice for most preterm infants, however, preterm infant formula is at times a critical alternative. It is the absence of human milk that increases NEC risk rather than toxic components in preterm infant formula.