Background A care bundle has been launched in the East of England to reduce the incidence of necrotising enterocolitis (NEC). As part of this initiative, we conducted a retrospective study of all NEC cases managed in the region in 2009.

Aim To evaluate the burden of NEC and its outcome in the East of England.

Methods A case of NEC was defined as ‘an infant developing clinical features of NEC leading to commencement of antibiotics and stopping of feeds, both for a minimum of seven days’. Cases were identified from SEND and were cross-checked with individual unit databases. Data was collected from all 18 units in the region. Modified Bell's staging was used to characterise the infants.

Results 101 infants were treated for 112 episodes (incidence: 1.28/100 admissions). Total confirmed cases were 86 (incidence: 0.92%). 44% of cases were Bell's stage I, 20.3% cases stage II and 36.7% cases stage III. Mean gestation was 28 weeks 3 days (23 weeks 2 days–40 weeks 6 days), mean birth weight 1021 g (95% CI 989.5 to 1052.5). 53.7% cases were treated conservatively and 44.6% needed surgical intervention. 28 infants (25%) died, 2 before surgery. Highest mortality (72.7%) was noted in stage 3a. The incidence in level 3 units (1.8%) was significantly higher than level 2 and 1 units (1%). Availability of surgical facilities did not improve mortality in level 3 units.

Conclusion This region has a lower incidence of NEC compared to available national data but the mortality is high and needs strict surveillance.