When a premature baby develops NEC, most families assume the formula is the only issue. And while cow’s milk-based formulas like Similac are a major factor, the reality is more complex. In many NEC cases, the hospital itself bears significant responsibility.
NICU staff are trained to follow specific protocols for feeding premature infants, monitoring for early NEC symptoms, and responding when things go wrong. When those protocols are not followed, the consequences can be catastrophic. And when that happens, families have the right to hold the hospital accountable.
Why Most NEC Law Firms Miss This
The majority of firms advertising NEC cases only pursue claims against formula manufacturers like Abbott and Mead Johnson. They do not investigate what happened inside the NICU because they lack the medical expertise to review the records.
The Alvarez Law Firm is different. Our team includes Herb Borroto, M.D., J.D. — a licensed physician with a law degree who personally reviews NICU medical records, feeding logs, and nursing notes to identify deviations from the standard of care. This allows us to pursue both product liability and medical malpractice claims simultaneously — an approach that can significantly increase your family’s total recovery.
Types of Hospital Negligence That Cause or Worsen NEC
NEC hospital negligence takes many forms. Here are the most common failures our medical-legal team identifies when reviewing NICU records.
1. Improper Feeding Protocols
Evidence-based guidelines are clear: premature infants should receive mother’s own milk as the first choice for feeding. When mother’s milk is not available, pasteurized donor human milk should be used — not cow’s milk-based formula. Research shows that donor milk is associated with approximately a 50% reduction in NEC risk compared to preterm formula.
NICU standard of care also requires careful feeding advancement — increasing volumes gradually (typically no more than 20 mL/kg/day) while monitoring for signs of intolerance. Advancing feeds too quickly can overwhelm an immature digestive system and trigger NEC.
When a hospital feeds a premature infant formula without first exhausting breast milk and donor milk options, or advances feeds too aggressively, and NEC results, that can constitute negligence.
2. Delayed or Missed Diagnosis
NEC has recognizable early warning signs. NICU staff are trained to watch for abdominal distension (a swollen, tight belly), feeding intolerance or refusal, bloody stools, bile-stained vomiting, lethargy, temperature instability, and apnea (pauses in breathing).
When these symptoms appear, the standard of care requires prompt diagnostic evaluation — typically including abdominal X-rays, lab work, and suspension of feeds. NEC can progress from early inflammation to life-threatening intestinal perforation within hours. Any delay in recognizing symptoms, ordering diagnostics, or initiating treatment can allow the condition to worsen dramatically — turning a treatable case into a surgical emergency or a fatal outcome.
3. Delayed Surgical Intervention
When NEC progresses to Stage III (advanced disease with intestinal perforation or necrosis), surgical intervention is required. This typically involves removing the dead or perforated sections of intestine. Delaying surgery once it becomes necessary can lead to widespread infection (sepsis), additional intestinal damage, short bowel syndrome, and death. If the surgical team was not consulted in time or if the operation was delayed unnecessarily, this may constitute malpractice.
4. Failure to Support Breast Milk
Current guidelines recommend that mothers of premature infants be encouraged to begin expressing breast milk within 6 hours of delivery, and that trophic feeds of mother’s own milk begin as soon as medically appropriate — typically within 24 to 48 hours of birth. When hospitals fail to encourage early pumping, do not provide lactation support, or default to formula without adequately explaining the NEC risk to parents, they may be failing to meet the standard of care.
5. Inadequate Monitoring
Premature infants in the NICU require continuous monitoring. Vital signs, abdominal exams, feeding tolerance assessments, and routine lab work are all part of standard neonatal care. When monitoring lapses — whether due to understaffing, shift change failures, or simple inattention — early signs of NEC can be missed, and the condition can progress to a critical stage before anyone intervenes.
Hospital Negligence Verdicts: The $32 Million Connecticut Case
In December 2025, a Connecticut judge awarded nearly $32 million to the parents of a premature infant who died after developing NEC at Yale New Haven Hospital. The infant was fed cow’s milk-based formula in the NICU and subsequently developed NEC, leading to respiratory failure, multi-organ failure, and death.
This case illustrates a critical point: hospital liability and formula manufacturer liability can overlap. The hospital’s feeding decisions and the manufacturer’s failure to warn can both contribute to the same injury. Families who only pursue one claim may be leaving significant compensation on the table.
How We Prove Hospital Negligence in NEC Cases
Medical malpractice cases require establishing four elements: a duty of care, a breach of that duty, causation, and damages. In NEC hospital negligence cases, this means showing that the NICU staff deviated from accepted neonatal care standards and that this deviation caused or worsened your baby’s condition. Here is how we build these cases:
Medical Record Review by a Physician-Attorney
Herb Borroto, M.D., J.D. personally reviews the NICU medical records — including admission notes, daily progress notes, feeding logs, nursing assessments, imaging studies, and surgical records. His medical training allows him to identify deviations from the standard of care that a lawyer without medical expertise would miss.
Timeline Reconstruction
We build a detailed chronology of your baby’s NICU stay — every feeding, every vital sign, every symptom noted (or not noted), every diagnostic test, and every clinical decision. This timeline reveals where care deviated from what the standard required.
Expert Neonatologist Testimony
Medical malpractice cases require expert testimony from qualified professionals. We work with board-certified neonatologists who can testify about what the standard of care required and how the hospital’s care fell short.
Causation Analysis
We establish the connection between the hospital’s failures and your baby’s NEC outcome — showing that proper care would have prevented or reduced the severity of the condition.
Can I Sue Both the Hospital and the Formula Manufacturer?
Yes — and in many cases, you should. NEC often involves multiple causes and multiple responsible parties. A premature infant may have been fed formula that elevated their NEC risk (manufacturer liability) and received substandard NICU care that failed to prevent, diagnose, or treat the condition (hospital liability).
Pursuing both claims simultaneously gives your family the strongest legal position and the greatest potential for maximum compensation. These are separate legal theories with separate defendants, and recovering on both is entirely possible.
This dual-track approach is exactly what The Alvarez Law Firm is built for. With a Board Certified trial lawyer handling the litigation strategy and a physician-attorney analyzing the medical evidence, we pursue every responsible party. For more on the formula manufacturer side, see our Similac NEC Lawsuit page.
⚠ Medical Malpractice Deadlines Are Often Shorter
Medical malpractice statutes of limitations are often shorter and more complex than product liability deadlines. Many states impose strict filing requirements — including pre-suit notice periods, affidavit-of-merit requirements, and shorter overall deadlines.
While many states extend deadlines for minors, the rules vary significantly by state. If you believe hospital negligence contributed to your baby’s NEC, the time to consult an attorney is now — not when a deadline is approaching. We can evaluate your state’s specific requirements during a free case review.
Frequently Asked Questions
What if I signed a consent form at the hospital?
Consent forms do not waive your right to sue for negligence. A consent form acknowledges that medical procedures carry inherent risks — it does not authorize substandard care. If the hospital failed to meet the accepted standard of care, a consent form will not protect them.
What if I was never told about the NEC risk from formula?
This could strengthen your case. If the hospital fed your premature infant formula without adequately informing you about the elevated NEC risk and without offering breast milk or donor milk alternatives, this failure of informed consent may constitute an additional basis for liability.
How long do NEC hospital negligence cases take?
Medical malpractice cases are typically more complex and take longer than product liability cases. They require detailed expert analysis, pre-suit notice in some states, and extensive discovery. Most NEC medical malpractice cases take 1 to 3 years to resolve, depending on the complexity and the state. Our firm keeps families informed at every stage of the process.
What if my baby’s NEC was caused entirely by the hospital, not formula?
You may still have a strong claim. Not every NEC case involves formula. Some cases are caused entirely by hospital failures — delayed diagnosis, improper monitoring, feeding protocol violations, or substandard neonatal care. If the hospital’s negligence caused your baby’s NEC, you can pursue a medical malpractice claim regardless of whether formula was involved.
Was Your Baby’s NICU Care Below Standard?
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