In a 4 year and 4 month period 80 patients with necrotizing enterocolitis were treated. Review of the mode of clinical presentation, radiological features, management, mortality, and complications showed that there have been considerable changes over this period. The disease is now frequently diagnosed clinically prior to the development of paralytic ileus. Scalloping of the bowel wall and separation of the bowel loops are probably the earliest radiological signs. The management has become a more aggressive medical approach with more limited and well-defined surgical indications. These changes have been associated with a marked decrease in mortality and a concomitant increase in the number of late complications.