In neonates with necrotizing enterocolitis, which of the following findings is an indication of significant bowel ischemia?

E. Erythema of the abdominal wall.

DISCUSSION: Necrotizing enterocolitis (NEC) is a condition that occurs in 2% of babies admitted to neonatal intensive care facilities. Increased gastric residuals can occur for a number of reasons and are seen as an early indicator of NEC, but they may not reflect the presence of ischemic bowel. Septic shock may be due to a wide variety of causes besides NEC. Cardiac failure due to patent ductus arteriosus may predispose to NEC but is not necessarily an indicator of ischemic bowel. Most babies with NEC have a progressive decrease in their platelet count in association with bowel ischemia. Erythema of the abdominal wall is an indication for surgical exploration and is consistent with NEC with perforation and inflammation of the peritoneum and abdominal wall.