Historical Perspectives

Abstract

Perhaps the least well understood of the disorders of prematurity is necrotizing enterocolitis (NEC). Although it is not certain when this problem initially was observed, it was well described in 1964 by Berdon and coworkers at Babies Hospital in New York, (1) with amplification from the same group in slightly later publications. (2)(3) A group in Seattle also contributed important observations of a significant number of survivors in a comparatively large series (4) and an increased frequency of the disorder in the late 1960s. (5) The role of radiographic interpretation was emphasized in these later reports, with pneumatosis intestinalis considered the hallmark of the disorder. It subsequently was emphasized that a provisional diagnosis was required before pneumatosis was evident to allow for medical rather than surgical intervention. (6) Even in the early reports, the very low-birthweight (VLBW) infant (<1,500 g) born before 32 weeks’ gestation seemed to be particularly susceptible, although larger and more mature infants also could be affected. Both then and now, NEC was and is a disorder of uncertain etiology. (7)(8) The role of bowel ischemia seemed to be paramount, with bacterial infection and method of feeding being other important contributors. Although infection seemed to be important, it was not possible to isolate a responsible organism in many cases. Despite this, the periodicity of the disorder in nurseries and the ability to reduce the incidence by infection control measures (9) was highly suggestive of the potential importance of infection (possibly viral). The ability of human milk to protect against NEC in the VLBW infant is well established, (10) and minimal enteral nutrition over several days also has been shown to decrease the incidence of NEC in VLBW infants. (11) At one point, the idea that NEC was a form of inflammatory …