Initiation of oral intake in neonates with surgical necrotizing enterocolitis: a road map

Necrotizing enterocolitis (NEC) is a severely life-threatening gastrointestinal emergency in newborns, especially when surgical intervention is needed. The ideal time for resuming oral feeding after surgery is still unclear, leading to variations in practice and prolonged parenteral nutrition. This study aims to develop and validate a scoring system to determine the best time to reintroduce oral feeding in neonates following surgical NEC.

A multicenter retrospective study was conducted from 2016 to 2024, including 500 neonates with surgical NEC (Bell's Stage III-IV). Patients were divided into early (5 days), intermediate (8-14 days), and delayed (≥ 15 days) feeding groups. A predictive score was constructed on 100 patients using eight preoperative, intraoperative, and postoperative variables. Validation was performed on an independent cohort of 400 patients.

The scoring system demonstrated strong predictive accuracy (AUC = 0.967). Variables such as localized pneumatosis, absence of portal venous gas, higher platelet count, no second-look laparotomy, and early normalization of nasogastric aspirates and lab parameters were significantly associated with early feeding tolerance (p < 0.05). Validation confirmed reproducibility across cohorts without NEC recurrence or feeding-related complications.

We present a validated, clinically practical scoring system to guide early oral intake initiation after NEC surgery. It enables stratified decision-making, reduces reliance on parenteral nutrition, and enhances postoperative recovery.