Necrotizing enterocolitis (NEC) is a serious intestinal problem that affects newborns and sometimes requires surgery. After surgery, doctors aren’t always sure when babies are ready to start eating again, so they often rely on feeding tubes and IV nutrition for longer than necessary. Researchers studied 500 newborns who had NEC surgery and created a scoring system—like a checklist—to help doctors decide the best time to start feeding babies again. The system looks at things like blood test results, how much fluid is coming from the stomach tube, and what the surgery showed. When tested on 400 more babies, the system worked really well and helped babies start eating sooner without problems.

The Quick Take

  • What they studied: Can doctors use a simple scoring system to figure out when newborns with serious bowel problems are ready to start eating after surgery?
  • Who participated: 500 newborn babies who had surgery for necrotizing enterocolitis (a serious intestinal infection) between 2016 and 2024. The babies were divided into groups based on when they started eating again: very early (5 days), medium (8-14 days), or late (15+ days after surgery).
  • Key finding: The scoring system was 96.7% accurate at predicting which babies could safely start eating early after surgery. Babies with certain signs—like normal blood counts, no gas in the liver blood vessels, and clear stomach fluids—did well with early feeding and had no problems.
  • What it means for you: If you have a newborn who needs NEC surgery, this research suggests doctors may be able to start feeding your baby sooner than they currently do in many hospitals. This could mean less time on IV nutrition and faster recovery. However, this is a new tool that hospitals will need to adopt and test in their own settings.

The Research Details

Researchers looked back at medical records from 500 newborns who had surgery for necrotizing enterocolitis over 8 years. They identified 8 important signs that doctors could check before, during, and after surgery—things like blood cell counts, what the surgery revealed, and how the baby’s stomach was draining. Using 100 babies’ information, they created a scoring system that assigns points based on these signs. Then they tested this system on 400 different babies to make sure it actually worked.

The scoring system is like a medical checklist. Doctors look at specific information about each baby and add up points. A higher score suggests the baby is ready for early feeding. The researchers tracked which babies did well with early feeding and which ones had problems, then checked if the scoring system correctly predicted the outcomes.

This approach is called a retrospective study because researchers looked at information that was already collected, rather than following new babies forward in time. It’s a practical way to develop tools that can be used right away in hospitals.

Currently, doctors use different approaches to decide when to feed babies after NEC surgery, which means some babies get fed too early (risking complications) while others wait too long (missing out on nutrition). A validated scoring system removes guesswork and helps all doctors make consistent, safe decisions. This is especially important because feeding decisions directly affect how quickly babies recover and how long they need expensive IV nutrition.

This study has several strengths: it included 500 babies from multiple hospitals, used a large independent group to test the system, and tracked real outcomes over 8 years. The system showed very high accuracy (96.7%), which is excellent. However, the study looked backward at existing records rather than following new babies forward, which is less powerful than a prospective study. The research was published in a peer-reviewed medical journal, meaning other experts reviewed it before publication. The fact that the system worked well in both the development group and the validation group suggests it’s reliable.

What the Results Show

The scoring system successfully predicted which babies could safely start eating early after NEC surgery with 96.7% accuracy. This is an excellent result—it means the system correctly identified safe candidates for early feeding almost all the time.

Babies who scored high on the system (indicating readiness for early feeding) had several things in common: their blood platelet counts were higher, they didn’t have gas in the blood vessels of their liver (a bad sign), they didn’t need a second surgery to look at their intestines again, and their stomach drainage and blood tests returned to normal quickly. These signs suggest the baby’s body is healing well and can handle food.

When doctors used this scoring system to guide feeding decisions, babies started eating sooner than they would have with standard approaches. The early-feeding group started eating around day 5 after surgery, compared to day 15 or later in the delayed-feeding group. Importantly, babies who started eating early didn’t have more problems—they didn’t get NEC again, and they didn’t have feeding-related complications.

The system worked equally well when tested on a completely different group of 400 babies from the same hospitals, proving it’s reproducible and reliable.

The research identified specific warning signs that suggest a baby is NOT ready for early feeding. These include: having gas in the liver blood vessels (portal venous gas), needing a second surgery to check the intestines, lower platelet counts, and slow normalization of stomach drainage and blood tests. Babies with these signs did better waiting longer before starting to eat. The study also found that the location of the intestinal damage mattered—babies with damage limited to one area did better with early feeding than those with widespread damage.

Previous research has suggested that early feeding after NEC surgery might be beneficial, but doctors haven’t had a reliable way to identify which babies are safe candidates. This study builds on that earlier work by providing a specific, validated tool. Unlike general guidelines that apply to all babies the same way, this scoring system allows personalized decision-making based on each baby’s individual recovery signs.

This study looked at babies’ medical records after the fact rather than following new babies forward in time, which is less powerful than a prospective study. The research was done in specific hospitals in one region, so results might differ in other hospitals with different practices or patient populations. The study didn’t compare the new scoring system directly against doctors’ current decision-making methods, so we don’t know exactly how much better it is. Additionally, the study included only babies with the most severe NEC (stages III-IV), so the results may not apply to babies with milder disease. Finally, hospitals will need to test this system in their own settings before fully adopting it.

The Bottom Line

Based on this research, hospitals should consider adopting this scoring system to guide feeding decisions after NEC surgery (moderate-to-high confidence). The system appears safe and effective at identifying babies ready for early feeding. However, individual doctors should still use clinical judgment and consider each baby’s unique situation. Parents should discuss feeding timelines with their medical team and ask if the hospital uses evidence-based scoring systems for these decisions (moderate confidence).

This research is most relevant to parents of newborns who develop necrotizing enterocolitis requiring surgery, neonatal surgeons, and pediatric intensive care doctors. It may also interest hospital administrators looking to improve outcomes and reduce costs. This research does NOT apply to babies with mild NEC that doesn’t require surgery, or to feeding decisions in other newborn conditions. Healthy babies and families without NEC don’t need to apply this information.

If a baby is identified as a good candidate for early feeding using this scoring system, they might start receiving small amounts of milk within 5 days after surgery, compared to 15+ days with delayed approaches. Benefits like faster growth and reduced need for IV nutrition would likely appear over weeks to months. Full recovery typically takes several months, but earlier feeding may speed this process.

Want to Apply This Research?

  • For parents of babies recovering from NEC surgery, track feeding milestones: date feeding started, amount of milk per feeding, tolerance signs (no vomiting, normal stools), and dates of any setbacks. Record these alongside weight gain and dates of IV nutrition changes.
  • Parents can ask their medical team: ‘Does our hospital use a scoring system to guide feeding decisions after NEC surgery?’ and ‘Based on our baby’s current signs, what is the plan for starting feeds?’ This encourages evidence-based conversations about their baby’s care.
  • Long-term, parents should track their baby’s growth, feeding tolerance, and any signs of NEC recurrence (fever, feeding intolerance, abdominal swelling) for at least 6 months after surgery. Work with your pediatrician to monitor developmental progress and ensure adequate nutrition during recovery.

This research describes a new medical tool for hospital use and is not a substitute for professional medical advice. If your newborn has necrotizing enterocolitis or requires surgery, all feeding decisions must be made by your medical team based on your baby’s individual condition. This study shows promising results but represents one hospital’s experience—outcomes may vary in different settings. Always consult with your neonatal surgeon and pediatrician about the best feeding approach for your baby. Do not attempt to apply this scoring system without medical supervision.