Feeding practices for infants weighing less than 1500 G at birth and the pathogenesis of necrotizing enterocolitis

This article examines clinical issues regarding gut maturation, gut colonizatiion, gut luminal starvation, a germ-free gut, and the role of enteral intake in the pathogenesis of necrotizing enterocolitis (NEC) in very low birth weight neonates and micropremies. NEC is identified as the final common pathway for a variety of etiologic mechanisms, only one of which is consistent with the enteral-based theory of NEC. The technique of minimal enteral intake ("gut priming") is discussed as a strategy to maintain the normal ontological processes of the developing gut ex utero. A combination of enteral plus parenteral intake is described to achieve nutritional goals.