Necrotizing enterocolitis (NEC) is a severe intestinal condition affecting infants in the neonatal intensive care unit (NICU) and the most common surgical emergency in that population (Patel et al., N Engl J Med 372:331–340, 2015). NEC primarily affects preterm infants but does occur in full-term infants. NEC contributes significantly to morbidity and mortality, including protracted intestinal failure and long-term neurodevelopmental impairment (Fullerton et al., J Pediatr Surg, 2017). Both the incidence and outcomes of the disease have not greatly improved over the past decades (Patel et al., N Engl J Med 372:331–340, 2015; Yee et al., Pediatrics 129:e298–304, 2012; Stoll et al., JAMA 314:1039–1051, 2015). The precise etiology of NEC remains elusive, and there is heterogeneity in the clinical presentation, likely reflecting different causal pathways to disease as well as different disease entities. Treatment is mainly supportive in nature, and therefore strategies that focus on prevention and early recognition of NEC are critical.