Abstract <p>The association between early antibiotic overuse in preterm neonates and the risk of necrotizing enterocolitis (NEC) remains controversial. In this issue of Pediatric Research, Zhu et al. present findings from a large multicenter prospective cohort study across China, reporting no significant association between early empirical antibiotic exposure and NEC. However, prolonged use of broad-spectrum antibiotics was associated with increased mortality. The results underscore the importance of antibiotic stewardship in neonatal care and highlight the need for further randomized trials and mechanistic studies to better understand the complex interactions between antibiotics and NEC pathogenesis.</p> Impact <p>This comment highlights the study by Zhu et al. ‘Early antibiotic exposure and necrotizing enterocolitis among preterm infants &lt;34 weeks’ gestation’.</p>