Despite contemporary advancements in the prevention and management of necrotizing enterocolitis (NEC), some aspects of management remain less rooted in clinical evidence. While there have been many studies over the last several decades evaluating the timing between initial stoma creation and closure, there is still no consensus on the optimal timing to restore intestinal continuity, nor even the definition of early versus late closure. Based on the preponderance of single center institution retrospective reviews, it appears that ostomy closure as early as around 6–8 weeks appears to be associated with low rates of complications, including significant intraoperative adhesive disease/ bowel injury or bleeding, or subsequent anastomotic complications. However, the patient’s clinical picture, including growth trajectory, parenteral nutrition-related liver disease, and ongoing need for respiratory support, will likely always remain the primary driver of a surgeon’s decision to return to the operating room. Additional questions which remain difficult to answer definitively include the necessity and/or impact of diagnostic testing (including any number of different contrast studies) and clinical management (i.e. distal refeeding) on successful and uncomplicated stoma closure.