World NEC Awareness Day: Uniting to Combat Necrotizing Enterocolitis

World NEC Awareness Day: Uniting to Combat Necrotizing Enterocolitis

Every year on May 17th, the global community joins together to observe World NEC Awareness Day, a day dedicated to raising awareness about Necrotizing Enterocolitis (NEC), a devastating condition affecting premature infants worldwide.

This special day serves as a rallying point for healthcare professionals, families, and advocates to shine a spotlight on NEC, its impact on infants and families, the importance of prevention, early detection, effective treatment, and support mechanisms. Dr. Amar Sundar Varma, Consultant Neonatologist and Pediatrician at Ankura Hospital, Hyderabad. Learn about the importance of breastfeeding, the use of donor human milk, and meticulous neonatal care practices to minimize infection risks. In this article, we will Learn about the importance of breastfeeding, the use of donor human milk, and meticulous neonatal care practices to minimize infection risks. Dr. Amar Sundar Varma, Consultant Neonatologist and Pediatrician at Ankura Hospital, Hyderabad shares  invaluable insights on “Navigating Necrotizing Enterocolitis (NEC): Understanding, Prevention, and Care Strategies”

Understanding NEC

NEC is a serious gastrointestinal disease that primarily affects premature infants, particularly those born before 32 weeks gestation or with very low birth weights <1500 g. NEC is characterized by inflammation and tissue death in the intestines, leading to severe complications such as perforation, sepsis, and long-term gastrointestinal issues., 

While the exact cause of NEC remains elusive, the key factors that contribute in the development of NEC include:

  • Prematurity
  • formula feeding or bovine-based feeds
  • low birth weight
  • bacterial colonization 
  • Early and longer use of antibiotics
  • Maternal factors like chorioamnionitis, preeclampsia, and smoking

Global Efforts on World NEC Awareness Day

World NEC Awareness Day serves as a platform for global collaboration and advocacy efforts to address the challenges posed by NEC. Healthcare organizations, advocacy groups, and individuals around the world organize events, share resources, and engage in educational initiatives to increase awareness about

NEC and its impact on premature infants and their families. By fostering dialogue and raising awareness, World NEC Awareness Day aims to drive action towards improved prevention, diagnosis, and treatment strategies for NEC.

Early Detection and Intervention

Early recognition and intervention are critical in mitigating the progression of NEC and improving outcomes for affected infants. Healthcare providers play a crucial role in promptly identifying the signs and symptoms of NEC. Diagnostic modalities such as radiographic imaging and laboratory tests aid in confirming the diagnosis and guiding treatment decisions. 

Signs of NEC include

Gastrointestinal signs: 

  • Feeding intolerance 
  • Increase abdominal girth 
  • Visible intestinal loops 
  • Decrease bowel sounds 
  • Blood in stools 
  • Constipation 
  • Diarrhea and/or dark or bloody stools 
  • Vomit containing bile 


  • Abdominal X-Ray: dilated bowel loops with forthy or soap bubble gas pattern and thickened bowel wall or presence of abdominal free air.
  • USG abdomen: Can detect intermittent gas bubbles in the liver and portal vein that are not detected by X-rays
  • Lab findings: Complete blood count showing elevated White Blood Cells (WBC), anemia, and decreased platelets.
  • Positive culture: urine, blood, or stool.

The Importance of Prevention

Prevention is paramount in reducing the incidence and severity of NEC. The preventive strategies include:

Feeding Human milk:

  • Breast milk, particularly the mother’s milk, provides vital nutrients and protective factors that help strengthen the infant’s immune system and reduce the risk of NEC and in the absence of mothers’ milk pasteurized donor human milk (PDHM) is preferred
  • Bioactive compounds present in human milk including human milk oligosaccharides (HMOs), immunoglobulins, and lactoferrin prevent NEC by supporting gut maturity, maintaining gut health by inhibiting pathogens, and promoting the absorption of essential nutrients.
  • Clinical evidence also supports human milk in reducing the incidence of NEC compared to formula.
  • Exclusive human milk diet (EHMD) is associated with a lower incidence of NEC than with a bovine milk-based diet.
  • Use of oropharyngeal colostrum supports in prevention of NEC by providing immunotherapy in preterm infants.

Restricting antibiotic use:

  • Prolonged use of antibiotics leads to dysbiosis which is imbalance of gut microbiota which is a risk factor contributing to NEC.

Implementing standard feeding protocol:

  • Following a standard feeding protocol provides a consistent approach in criteria to stop feeds, prevent feeding intolerance, criteria in handling feeding intolerance, and criteria to restart feedings

Use of antenatal steroids:

  • Use of antenatal corticosteroids promotes the maturation of intestinal cells.

Providing lactation support:

  • Lactation support and lactation support programs further help in implementing nutritional strategies enhancing breastfeeding.


World NEC Awareness Day serves as a powerful reminder of the collective commitment to combating Necrotizing Enterocolitis and improving outcomes for premature infants worldwide. By raising awareness, fostering collaboration, and advocating for evidence-based practices, we can work towards a future where NEC is no longer a significant threat to the health and well-being of vulnerable infants and their families. Together, let us continue to unite our efforts, amplify our voices, and drive positive change in the fight against NEC.


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