Necrotizing enterocolitis (NEC) remains one of the most serious and life-threatening gastrointestinal emergencies in newborns, particularly in preterm infants. For more than six decades, its complex and multifactorial pathogenesis has challenged neonatologists and pediatric surgeons. Recent advances in neonatal care, immunology, microbiome research, and surgical management have significantly improved understanding of disease mechanisms, risk factors, and outcomes. This work highlights ongoing efforts to enhance prevention, enable earlier diagnosis, and optimize medical and surgical treatment strategies for NEC. Key Features: Comprehensive overview of the epidemiology, pathophysiology, and risk factors of NEC Discussion of recent advances in understanding disease mechanisms and intestinal injury Focus on prevention strategies, including feeding practices and microbiome modulation Exploration of emerging tools for early recognition and diagnosis Review of current medical and surgical management approaches, including evolving operative strategies Relevant for neonatologists, pediatric surgeons, neonatal nurses, and trainees involved in neonatal intensive care