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Necrotizing enterocolitis (NEC) is the most common surgical gastroenterological emergency in neonates, with an unknown aetiology. We investigated the effect of early enteral feeding on NEC in neonated aged 24-32 weeks.Thirty-seven case-control pairs were identified from neonates admitted to the Neonatal Intensive Care Unit (NICU) of British Columbia Children's Hospital, Vancouver between January 1st 2002 and December 31st 2007.Early feeding was not associated with NEC (OR 0.6, 95% CI 0.79-1.47, P = 0.21). Sepsis was significantly associated with NEC (OR 6.5 95% CI 1.47, 28.8 P = 0.01). Neonates with NEC had longer duration on Total Parenteral Nutrition (TPN) (median days cases: 52, IQR 54; median days controls: 9, IQR 20, P = 0.0001) and longer admissions to the NICU (median days cases: 90, IQR 104; median days controls: 35 IQR 83, P = 0.003). Delayed enteral feeding (OR 1.67, 95% CI 0.61, 4.59, P = 0.45), neonates commenced on breast milk (OR 1.5, 95% CI 0.42, 5.32 P = 0.53) and formula fed neonates (OR 1.75, 95% CI 0.69-4.81 P = 0.30) were associated with increased odds of NEC, however results were not statistically significant.Neonates with NEC were more likely to have sepsis, required a higher number of days of TPN and longer NICU stays.