At the limit of viability: Outcomes of necrotising enterocolitis in neonates born before 25 weeks' gestation

To determine management outcomes and prognostic indicators for necrotising enterocolitis (NEC) in extremely premature neonates born at the threshold of viability (≤25 weeks).

A retrospective review of a prospectively maintained, consecutively recorded database of neonates born ≤25 weeks' gestation admitted with NEC to a tertiary neonatal unit between January 2020 and December 2025. Outcomes measured included survival to discharge, overall survival, and medium-term morbidity.

51 neonates with ≤25 weeks' gestation developed NEC. Mean GA was 24 weeks and BW 667 g, with male predominance (60.8%). 35 (68.6%) underwent surgical intervention, and 16 (31.4%) were managed medically. At the time of diagnosis, CRP was normal in 54.9%, and thrombocytopenia occurred in 56.8%. Overall survival was 76.5% and was similar between the surgical and medical cohorts: 77.1% (27/35) and 75.0% (12/16), respectively (p = 1.000). Among survivors, CLD affected 83.8%, tube feeding dependency 29.7%, and Grade 3/4 IVH 13.5%. Infants born at 22-23 weeks achieved a survival rate of 76.5%. Among survivors, rates of CLD, Grade 3/4 IVH, and feeding-tube dependence were 84.3%, 15.4%, and 69.2%, respectively.

NEC in neonates born at the threshold of viability show promising survival, implying that extreme prematurity shouldn't exclude surgical treatment. Survivors experience significant comorbidities, especially chronic respiratory and nutritional morbidity. Collecting long-term neurodevelopmental data is crucial for family counselling and future care.