Sir .—The article "Neonatal Necrotizing Enterocolitis in the Absence of Pneumatosis Intestinalis" by Kliegman and Fanaroff (Journal1982;136: 618-620) draws attention to the important observation that neonatal necrotizing enterocolitis (NEC) is not always associated with radiologic evidence of intramural intestinal gas (pneumatosis intestinalis). Nineteen of their 136 patients with confirmed NEC did not have pneumatosis intestinalis; five patients had radiologic evidence of ascites, a finding indicative of usually severe NEC in the proper clinical circumstances. 1 The authors do not state if the remainder of these patients had a normal radiologic appearance on abdominal films. As Kliegman and Fanaroff point out, NEC without pneumatosis intestinalis (and without the other well-known signs of portal venous gas and pneumoperitoneum) has been reported before, including patients with histologic confirmation of NEC. 2,3 Such patients usually have what is known as a "disturbed bowel gas pattern" that is most often characterized by the presence