Possible causes include hypoxic damage to the small bowel which may be associated with umbilical catheterisation, apnoeic spells, and septicaemia. Other factors include hypovolaemia, fluid overload, exchange transfusion, patent ductus arteriosus - and treatment with indomethacin - and hyperosmolar feeds.
The infective organism is non specific, but anaerobes in the intestine may be contributary.
Outbreaks appear to take place in units, where several neonates become affected in a short space of time, supporting an infectious aetiology.
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