〔Abstract〕 Objective To investigate the perinatal-related high-risk factors affecting the survival outcome of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) premature infants. Methods The clinical data of 58 cases of NEC (Bell Ⅱ and above) VLBW premature infants admitted to Henan Provincial People's Hospital from January 2017 to September 2021 were retrospectively analyzed, and the children were divided into death group and survival group according to the outcome. Univariate analysis and multivariate logistic regression analysis were performed on the general clinical data and perinatal factors of the two groups, and the perinatal risk factors affecting the survival of VLBW premature NEC were screened. Results Among 58 NEC VLBW premature infants, 37 cases (63.8 %) survived and 21 cases (36.2 %) died. The gestational age and birth weight of VLBW premature infants in the death group were lower than those in the survival group, the proportion of vaginal delivery was higher than that in the survival group, and the proportion of Apgar score (1 min) < 7 was higher than that in the survival group, the differences were statistically significant (P < 0.05). Multivariate logistic regression analysis showed that high birth weight (OR = 0.996, P = 0.000) was a protective factor for NEC survival of VLBW premature infants, and vaginal delivery (OR = 12.435, P = 0.031) was a risk factor. Conclusion The survival outcome of NEC in VLBW premature infants is related to various factors in the perinatal period. Small gestational age, low birth weight, asphyxia at birth, and vaginal delivery of the mother may affect their survival. Vaginal delivery is a high-risk factors affecting the survival of NEC in VLBW premature infants. Maternal perinatal health, reducing the risk of preterm birth, reducing neonatal asphyxia at birth, and choosing an appropriate delivery method can help improve the survival rate of NEC preterm infants.