Necrotizing Enterocolitis and Enteral Feeding

Ever since Berdon et al1and Mizrahi et al2characterized neonatal necrotizing enterocolitis (NEC) as a distinct clinical entity, pediatricians have been searching for a unified concept of pathogenesis. Recent reports have attempted to synthesize the multiple factors associated with NEC and have proposed that the critical underlying pathogenic mechanism is either a defect in the integrity of the intestinal mucosal barrier3or a primary infectious process.4 Goldman, in this issue of theJournal(see p 553), refocuses our attention on the role of enteral feeding and more specifically overfeeding. In a 13-year review of the experience of one large neonatal unit, he noted that 25 of 26 cases of NEC developed in the three-year period when large feeding volumes (> 150 mL/kg/day) or large daily increases in volume (> 60 mL/kg/day) were the standard practice. When the nursery routine was changed back to limited