Vasopressin: the missing agent in neonatal necrotizing enterocolitis--a hypothesis.

The pathogenesis of neonatal necrotizing enterocolitis (NNEC), a common lethal complication of low birth weight infants, has not been established. The pathological changes are the result of mesenteric ischaemia. The disease is nearly always preceded by a period of stress, frequently the respiratory distress syndrome. This article demonstrates that the stress-related precursors of NNEC are potent stimuli for the release of vasopressin and that vasopressin can cause ischaemic intestinal necrosis when used therapeutically in the treatment of portal hypertension. Evidence is presented to show that it is vasopressin, not sympathetic stimulation, which mediates the selective mesenteric vasoconstriction of NNEC.