(B) (Increased bowel sound) (61-3- Nelson 19th)Stage II - Bowel sounds are diminished with or without abdominal tenderness, metabolic acidosis with mild thrombocytopenia.Stage III - Low B.P. bradycardia, apnea, DIC and even anuria.NEONATAL NECROTIZING ENTEROCOLITIS* NEC is the most common life threatening emergency of the GIT in the newborn period, usually in the 2nd or 3rd week of life.* Many factors may contribute to the development of a necrotic segment of intestine, gas accumulation in the submucosa of the bowel wall (pneumatosis intestinalis) and progression of the necrosis to perforation, peritonitis, sepsis and death.* The distal part of the ileum and the proximal segment of colon are involved most frequently.* Triad -(i) Intestinal ischaemia (Injury)(ii) Enternal nutrition (Metabolic substrate)(iii) Bacterial translocation* Aggressive enteral feeding may predispose to the development of NEC.* NEC in term infants is often a "secondary" disease seen more frequently in infant with history of birth asphyxia, Down syndrome, congenital heart disease, rotavirus infection and Hirschsprung disease.* Signs and symptoms associated with NEC.(A) Gastrointestinal - Abdominal distension, tenderness feeding intolerance, delayed gastric emptying, vomiting, ocult/gross blood in stool, change in the stool pattern, diarrhea, abdominal mass, erythema of abdominal wall.(B) Sytemic - Lethargy, Apnea/Respiratory distress, Temperature instability, "Not right" Acidosis (metabolic and/or respiratory) Glucose instability. Poor perfusion/shock DIC, Positive results of blood cultures.Plain abdominal X-ray - pneumatosis intestinalis {air in the bowel wall) confirm the clinical suspicion of NEC and is diagnostic, Portal venous gas is a sign of severe disease and pneumoperitoneum indicates a perforation.