Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has a high mortality rate, particularly in infants with a birthweight of below 1,500 g or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe's top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding, and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every 5 years to ensure it remains up to date.

Care4Neo Neonatal Patient and Parent Advocacy Organization Rotterdam The Netherlands

Department of Abdominal Surgery University Hospital Gasthuisberg Leuven Belgium

Department of Developmental Biology and Cancer UCL GOS Institute of Child Health London UK

Department of Evidence Based Medicine and Methodology Qualicura Healthcare Support Agency Breda The Netherlands

Department of Neonatal and Pediatric Intensive Care Erasmus Medical Center Sophia Children's Hospital Rotterdam The Netherlands

Department of Neonatology Azienda Ospedaliera di Padova Padua Italy

Department of Neonatology Karolinska University Hospital Solna Sweden

Department of Neonatology University Medical Center Groningen The Netherlands

Department of Pediatric Surgery Amsterdam Academic Medical Center Amsterdam The Netherlands

Department of Pediatric Surgery Azienda Ospedaliera di Padova Padua Italy

Department of Pediatric Surgery Centre Hospitalier Universitaire de Lille Lille France

Department of Pediatric Surgery Erasmus Medical Center Sophia Children's Hospital Rotterdam The Netherlands

Department of Pediatric Surgery Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Pediatric Surgery IRCCS Ospedale Pediatrico Bambino Gesù Rome Italy

Department of Pediatric Surgery Karolinska University Hospital Solna Sweden

Department of Pediatric Surgery Sant Joan de Déu Barcelona Children's Hospital Barcelona Spain

Department of Pediatric Surgery Universitätsklinikum Bonn Bonn Germany

Department of Pediatric Surgery Universitätsklinikum Frankfurt Frankfurt Germany

Department of Pediatric Surgery Universitätsklinikum Hamburg Eppendorf Hamburg Germany

Department of Pediatric Surgery University Hospital Motol Prague Czechia

Division of Pediatric Surgery Department of Surgery University Medical Center Groningen The Netherlands

NEC UK Representative Ruislip UK

Pediatric Department Vittore Buzzi Children's Hospital University of Milan Milan Italy

Section of Pediatric Surgery New Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland

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