Necrotizing enterocolitis (nec) is a very serious illness of the intestinal tract. The incidence of nec in a neonatal intensive care unit varies from 1 to 5%. Although the etiology is still not known, evidence suggests a multifactorial cause of the disease in which activated inflammatory mediators finally cause inflammation and necrosis of the bowel. Platelet activating factor (paf) is supposed to be one of the most important mediators. The primary risk factor for nec is prematurity. Other factors include infection, bowel ischemia and exposition of the premature bowel to enteral feedings. nec is mostly seen in extremely prematures and prematures with growth retardation (birthweight less than 10th percentile). nec is known for its serious course. About 30% of the patients die during the course of the disease. Different strategies to prevent nec are still unsatisfactory to eliminate nec. In the future, more understanding is expected to come from extended knowledge of the role of inflammatory mediators.