TLR4 and necrotizing enterocolitis: One example is PAF, which can simultaneously upregulate TLR4 to induce necroptosis and the NF-κB pathway to suppress necroptosis.6,38 Another example is TNF-ɑ, which plays an important but complicated role in the shifting balance between apoptosis and necroptosis.6 Clinical investigations have also shown that breast milk protects against NEC partly by inhibiting necroptosis.24 Most of the factors involved in NEC are multifunctional and may play dual roles in the development of NEC; thus, further examination of the interactions among several cell death mechanisms in NEC would be interesting.