What is the most significant risk factor for developing NEC?

The most significant risk factor for developing necrotizing enterocolitis (NEC) is prematurity. This condition predominantly affects premature infants due to their underdeveloped gastrointestinal systems. Premature infants often have immature intestinal barriers and inadequate blood flow to the intestines, making them more susceptible to enteric infections and an inflammatory response that leads to NEC.

While low birth weight is associated with an increased risk, it is often a consequence of prematurity. Maternal drug use is a risk factor for numerous neonatal complications, but it is not specifically linked to an increased likelihood of NEC as strongly as prematurity is. High gastric pH can affect the digestion and assimilation of nutrients, but it does not have the same direct relationship with the onset of NEC compared to the intrinsic vulnerabilities present in premature infants. Therefore, the understanding of NEC highlights that immaturity of the intestinal system due to prematurity is the most critical factor influencing its development.