Necrotizing enterocolitis is one of the most common gastrointestinal emergencies in the newborn infant,that affects primarily premature infants. It is a disorder characterized by ischemic necrosis of the intestinal mucosa. The pathogenesis of necrotizing enterocolitis is still unresolved, but it is postulated that it is multifactorial and involve an overreactive response of the immature immune system to an insult. That activate cascade of cellular invents, mediated by various inlammatory mediators and leads to increased intestinal permeability, and abnormal bacterial colonization.The clinical presentation is characterized by a sudden change in enteral feeding tolerance, which can be presented by various abdominal and non-specific findings. Also, the timing of the onset of symptoms can help in differential diagnosis as it seems to be inversly related to gestational age. Bell staging criteria define the severity of NEC, based upon the severity of clinical and radiographic findings. Diagnosis is based upon the presence of the characteristic clinical features, and the abdominal radiographic finding of pneumatosis intestinalis, pneumoperitoneum or hepatobiliary gas. Results of laboratory evaluation, including blood studies and stool analysis, may be suportive of the diagnosis of NEC. Conservative management is appropriate in most cases and consists of cessation of enteral feeding, supportive treatment, antibiotic therapy, and clinical, laboratory, as well as radiological re-evaluation. However, infants with advanced necrotizing enterocolitis and bowel perforation require surgical intervention, although it is often accompanied with long term complications, including short bowel syndrome and neurodevelopmental delay. Efforts to minimize the frequency or severity of NEC are directed at reducing exposure to risk factors and finding appropriate preventive strategies.