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Pneumatosis coli in preterm neonates: Can they be managed more conservatively to maintain the intestinal milieu?
  1. Elis Yuexian Lee1,
  2. Eric Ma1,
  3. Amudha Jayanthi Anand1,2,3,4 and
  4. Suresh Chandran1,2,3,4
  1. 1Department fo Neonatology, KK Women's and Children's Hospital, Singapore
  2. 2Paediatric Academic Clinical Programme, Duke NUS Medical School, Singapore
  3. 3Paediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore
  4. 4Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore
  1. Correspondence to Professor Suresh Chandran, Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore; profschandran2019{at}


Necrotising enterocolitis (NEC) is a severe gastrointestinal disease mostly in premature infants due to intestinal necrosis. The aetiology of NEC is multifactorial and includes gut immaturity, intestinal dysbiosis and exaggerated intestinal mucosal reactivity to microbial ligands. Radiographic evidence of pneumatosis intestinalis has been a critical feature for diagnosing NEC Bell stage ≥IIA and recommended treatment includes prolonged antibiotics (7–14 days) while off enteral feeds. Pneumatosis coli (Pcoli), a mild or benign form of NEC, is characterised by pneumatosis limited to the colon in an infant having haematochezia, negative septic screening and no systemic signs. We report two healthy preterm infants with haematochezia and colonic pneumatosis while on breast milk feeds. The sepsis screen was negative. A brief period of antibiotics and gut rest led to the spontaneous resolution of haematochezia and colonic pneumatosis, facilitating early enteral feeds. This case report emphasises the need to differentiate NEC from benign Pcoli.

  • GI bleeding
  • Neonatal health
  • Ultrasonography

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  • EYL and EM are joint first authors.

  • AJA and SC are joint senior authors.

  • Contributors EYL, EM: manuscript preparation, reviewed literature and added the references. AJA, SC: written the discussion and edited the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.