Necrotizing enterocolitis in a Chinese perspective: a narrative review

Background and Objective: Necrotizing enterocolitis (NEC) is one of the most life-threatening diseases in neonates. As a populous country, the incidence of NEC has increased in China, and some original viewpoints have been proposed recently. We aim to generalize the latest research on NEC in China and report some different opinions from a Chinese perspective in this review. Methods: We searched PubMed using the term "necrotizing enterocolitis" and "China" for articles published from July 2002 to June 2022. Those studies performed in the Chinese population and reported in English were included. Key Content and Findings: In China, the morbidity and mortality of NEC is comparable to that in other countries, and they can range based on the level of medical institutions and the regional economic development in China. Quantities of NEC cases are reported in term infants for whom breastmilk is introduced later. Risk factors such as transfusion, intrahepatic cholestasis and meconium aspiration syndrome have been proposed. For the diagnosis, the value of pneumatosis intestinalis and portal vein gas should be re-evaluated, and ultrasound examination as well as new manifestations on abdominal X-rays are being given more attention. New explorations of biomarkers, microbiota and metabolites based on the Chinese population are needed. Controversies regarding treatment, including the duration of fasting and decompression, the choices of antibiotics, especially the usage of anti-anaerobic treatment, and the safety and efficacy of probiotics still exist in China, and the exploration of ideal surgery indications will be a new direction in the future. Conclusions: Although great success has been achieved in NEC exploration based on the Chinese population, there is still a long and difficult road ahead for the clinical application of these new findings, and further research is needed.