Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency of neonates. Population studies estimate the incidence of NEC at between 0.3 and 2.4 per 1000 live births in the United States, with a predominance of cases among preterm neonates born at the earliest gestational ages. The disease burden of NEC includes an overall disease-specific mortality rate of 15-20%, with yet higher rates in those of earliest gestations. The NEC burden also includes an increase in hospital costs approximating $100,000/case, as well as severe late sequellae including parenteral nutrition-associated liver disease and short bowel syndrome. Differentiating NEC from other forms of acquired neonatal intestinal disease is critical to assessing the success of NEC prevention strategies. Promising new prevention strategies are now being tested; one such is prophylactic heparin-binding epidermal growth factor-like growth factor (HB-EGF) administration. However, two prevention strategies have already been shown in meta-analyses to reduce the incidence of NEC, but we speculate that these are not being fully utilized. They are; 1) implementing a written set of feeding guidelines (also called standardized feeding regimens) for newborn intensive care unit (NICU) patients, and 2) implementing programs to increase the availability of human milk for patients at risk of developing NEC.