title: Controversies in the management of necrotizing enterocolitis.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is the most frequent and lethal disease that affects the gastrointestinal tract of the premature infant. Controversy persists as to the most appropriate management once the diagnosis is confirmed.
  
  
  METHODS
  Review of the pertinent medical literature.
  
  
  RESULTS
  The incidence of NEC is increasing, but the survival rate is not. Initial management of NEC consists of bowel rest, orogastric decompression, intravenous hydration, and broad-spectrum antibiotics; surgical intervention is typically reserved for infants with advanced disease or evidence of intestinal perforation. There is no consensus in the literature regarding the optimal treatment strategy for patients who require surgical intervention. There exists a lack of randomized trials comparing definitive intestinal resection with or without primary anastomosis, intestinal diversion with limited resection, or peritoneal drainage without resection.
  
  
  CONCLUSIONS
  An individualized approach must be taken to achieve optimum survival for patients with NEC. Isolated perforation, in our opinion, is best managed with resection and enterostomy, whereas pan-intestinal involvement is best managed with proximal diversion alone.
authors.affiliation: Department of Surgery, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Nadler
authors.forename: J S
authors.initials: JS
authors.lastname: Upperman
authors.forename: H R
authors.initials: HR
authors.lastname: Ford
mesh_terms: D001291:Attitude of Health Personnel; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature