Which of the following signs should prompt evaluation for NEC in a neonate?

• A. Skin pallor
• B. Jaundice at birth
• C. Progressive abdominal distension
• D. Muscle tone deficits

Answer: (C)

Progressive abdominal distension in a neonate points to possible NEC because the illness starts with inflammation of the bowel that can rapidly worsen into necrosis and perforation. As the bowel becomes inflamed and gas-producing bacteria proliferate, the abdomen may visibly and palpably distend, signaling evolving intestinal injury that requires urgent evaluation. When this sign appears, the appropriate response is to perform a thorough abdominal assessment, monitor for feeding intolerance, vomiting (especially bilious), or bloody stools, and obtain imaging and labs to look for NEC indicators such as pneumatosis intestinalis or portal venous gas, along with signs of sepsis or metabolic disruption. Early imaging (abdominal radiographs) and labs guide management and help determine the need for urgent intervention. Other signs like skin pallor, jaundice at birth, or muscle tone deficits can reflect different problems (anemia, liver immaturity/hemolysis, neurologic issues or prematurity) and are not as specific to NEC as progressive distension.