Introduction. Necrotizing enterocolitis (NEC) is among the most severe gastrointestinal emergencies in the neonatal period, particularly afflicting preterm infants and significantly contributing to neonatal morbidity and mortality. Twin pregnancies are associated with an increased risk due to higher rates of prematurity and growth restriction. The occurrence of discordant NEC, in which only one twin is affected, illustrates the complexity of individual susceptibility. Methodology. A retrospective observational study was conducted over the period 2015-2025, including 26 neonates from 13 twin pregnancies. Three dichorionic, diamniotic twin pairs were identified in which gastrointestinal pathology suggestive of NEC occurred discordantly. The clinical presentation, imaging findings, management and outcomes were analyzed. Results. In all three twin pairs, only one neonate developed significant gastrointestinal pathology, whereas the co-twin experienced a favorable clinical course despite similar gestational age and shared prenatal factors. Conclusions. The occurrence of discordant necrotizing enterocolitis highlights the multifactorial and individualized nature of disease development, emphasizing the importance of personalized monitoring and early intervention strategies.
Vlădăreanu et al. (Thu,) studied this question.