Necrotizing Enterocolitis in a Term Newborn With Hypoxic-Ischemic Encephalopathy

Necrotizing enterocolitis (NEC) predominantly affects preterm infants and remains uncommon in term neonates. When it occurs in full-term newborns, it usually reflects underlying vulnerability or cumulative perinatal risk factors. We report the case of a term male newborn (40 + 1 weeks' gestation) who developed NEC in the context of multiple risk factors, including perinatal asphyxia with hypoxic-ischemic encephalopathy managed by therapeutic hypothermia, suspected early-onset neonatal infection requiring empirical antibiotics, and formula feeding. On day 4 of life, the infant presented with signs of an acute abdomen. Imaging revealed pneumoperitoneum, and surgery confirmed NEC with colonic perforation. Histopathology demonstrated inflammatory and hemorrhagic necrosis, and Hirschsprung's disease was excluded. A colostomy was performed, with restoration of intestinal continuity at six months and normal neurodevelopment at 18 months. This case highlights that NEC in term neonates, although rare, may result from the convergence of multiple perinatal insults, including hypoxic-ischemic injury and therapeutic hypothermia, and underscores the need for careful evaluation of predisposing factors that compromise intestinal integrity.