Necrotizing enterocolitis is a devastating gastrointestinal disease in the neonatal period, predominantly affecting preterm infants, and is characterized by high morbidity and mortality. Despite recent advances in prevention and management, there remains a lack of specific pharmacological therapies, and current clinical approaches largely rely on supportive care. This review summarizes the pathogenesis of necrotizing enterocolitis (NEC), involving factors such as prematurity, low birth weight, lack of breastfeeding, gut microbiota dysbiosis, and intestinal ischemia. Moreover, existing therapeutic strategies, including probiotics, antibiotics, human milk feeding, and stem cell therapy as preventive and interventional measures are discussed. Recent research progress focusing on modulation of the intestinal microbiota, targeting inflammatory signaling pathways, and novel formulation development is also highlighted. Finally, the challenges facing current drug development and future research directions are analyzed, aiming to provide theoretical foundations and innovative perspectives for precise interventions and new drug development in NEC.

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