**1. Introduction**

Necrotizing enterocolitis (NEC) is an acquired, multifactorial and devastating gastrointestinal disease associated with high morbidity and mortality in preterm neonates. With an incidence of about 7% in infants with BW < 1500 g and mortality up to 30%, NEC presents as a medical and surgical emergency [1, 2]. It is characterized by ischemia, necrosis, and inflammation of bowel wall with invasion by gas-forming organisms and intramural dissection of gas, characteristically appearing as pneumatosis intestinalis in radiological and pathological studies. While exact etiology is undetermined, the pathogenesis is believed to be an anomalous innate immune response to an altered, less diverse intestinal microbiota by the highly immunoreactive enterocytes of premature infants, leading to inflammation and tissue necrosis [3, 4]. The clinical presentation can be severe with cardiorespiratory collapse, shock, and disseminated intravascular coagulopathy (DIC), escalating

to multisystem failure and death [2]. About one third of the cases require surgical intervention due to intestinal perforation and gangrene [5]. NEC is the commonest gastrointestinal (GI) disorder of preterm newborn infants, although term infants can be affected. NEC is associated with significant adverse outcomes, and approximately half of the survivors suffer from abnormal neurodevelopment independent of maturational status at birth. It is one of the most important causes of intestinal failure in children. Despite substantial advances in its diagnosis, prevention, and management strategies, the incidence has not changed, especially in very low birth weight neonates, and the morbidity and mortality associated with necrotizing enterocolitis continue to be high.
