Abstract. OBJECTIVE: To evaluate epidermal growth factor (EGF) levels in cord blood as a possible marker for predicting the subsequent development of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. PATIENTS AND METHODS: A total of 241 VLBW infants (38 infants developed NEC and 203 had no NEC) were enrolled. EGF concentrations were measured by enzyme linked immunosorbent assay. RESULTS: VLBW infants who subsequently developed NEC had significantly lower cord serum concentrations of EGF than those who did not (p < 0.0001). Moreover, cord blood concentrations of EGF were significantly lower in infants with stage III than those with stage II or I NEC (p < 0.001). Logistic regression analysis demonstrated that low cord blood EGF was independently associated with the subsequent risk of NEC (OR = 0.978 [95% CI: 0.959–0.997]; p = 0.02). CONCLUSION: Low cord blood EGF concentrations may predict the subsequent development of NEC in VLBW infants.