We have recently identified that the activation of toll like receptor 4 (TLR4) within the intestinal epithelium plays a critical role in the early initiation of the steps that lead to enterocyte loss [5, 27–29], a finding that is supportive of studies by Jilling and colleagues showing that mice deficient in TLR4 were protected from NEC development [30]. This evidence concerns the gene TLR4 and necrotizing enterocolitis.