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This article discusses the effectiveness of various methods for identifying surgical necrotizing enterocolitis (NEC) in infants. A meta-analysis was conducted to determine the pooled sensitivity and specificity of these methods, and association of imaging features with disease severity was also examined. The majority of methods were derived or tested in single center studies and were produced and tested retrospectively. The most commonly used definition for NEC was Bell’s stage II and III or equivalent. Specific exclusion of infants with spontaneous intestinal perforation was reported in only 19.2% of methods.