This brief review of the current understanding of the
pathogenesis of NEC indicates the available and potential
pathways for primary prevention of this potentially disastrous
condition. The failure of strategies such as antenatal
glucocorticoids, and postnatal preferential use of human
breast milk, and a cautious approach to enteral feeding to
eliminate NEC in preterm neonates, indicates the need for
continued research in this area. Interventions such as arginine,
EGF and EPO seem to be promising, but need further
evaluation, including definitive clinical trials. However,In many preterm infants, there are related significant
limitations of the intestinal defense functions, such as
reduced integrity of epithelial tight junctions, deficiencies
in components of the mucus lining and deficiency of
IgA, which may contribute to the development of NEC
in preterm neonates. Intestinal epithelial integrity is
regulated by cyclooxygenases (COX),18 nitric oxide (NO)19
and epidermal growth factor (EGF).