Abstract: Objective　To analyze the clinical features of neonatal necrotizing enterocolitis (NEC) by comparison to spontaneous intestinal perforation (SIP). Methods　Medical records of infants with surgical NEC or SIP in the Children's Hospital of Chongqing Medical University between May 1996 and Aug. 2016 were retrospectively reviewed. The perinatal demography, comorbidities, complications and outcomes between the two groups were compared. Results　A total of 70 infants with surgical NEC and 31 infants with SIP were enrolled in the study, and the gestational age, birth weight and onset age were similar in both groups (P>0.05). Higher incidence of sepsis (47.1% vs. 12.9%, χ2=10.851, P=0.001) and hypoproteinemia (67.1% vs. 35.5%, χ2=8.808, P=0.003) were found in infants with NEC than those with SIP. The mortality was higher in infants with NEC than those with SIP (35.7% vs. 16.1%, χ2=3.947, P=0.047). Conclusions　Compared to infants with SIP, neonates with surgical NEC were associated with higher mortality due to higher incidence of sepsis and hypoproteinemia.