Necrotizing enterocolitis (NEC) remains one of the most challenging and poorly defined conditions in neonatal care. Internationally recognized neonatal researcher Dr. Josef Neu joins us to unpack the evolving science behind NEC—challenging traditional definitions and shedding light on the complex interplay between preterm gut development, the intestinal microbiome, and modern NICU practices. We explore the impact of antibiotics, feeding delays, and acid suppression on microbial balance, the critical role of maternal milk and skin-to-skin care, and the nuanced differences between donor and mother’s milk. Dr. Neu also discusses the latest evidence and controversies surrounding probiotics as well as introduces how artificial intelligence, machine learning, and multiomics are helping to identify distinct subtypes of intestinal injury. This episode offers cutting-edge insights and practical strategies for NICU nurses, APRNs, and providers committed to improving the early detection, prevention, and outcomes of NEC for vulnerable preterm infants.