Early descriptions of necrotizing enterocolitis (NEC) proposed gut ischemia as a primary factor in pathogenesis. Subsequent laboratory and clinical investigations have failed to support these theories, relegating most to positions of historical significance. Presently, the role of the circulation in the pathogenesis of NEC is unclear; however, several lines of ongoing investigation have begun to provide novel insight into the means by which circulatory aberration may initiate or contribute to the development of bowel necrosis.