Sir.—Warren et al1 suggest that massive hemolysis in the newborn with necrotizing enterocolitis (NEC) may be due to Clostridium perfringens infection. In our experience, by the time massive hemolysis is manifest, systemic spread of C perfringens, its toxin, or both will have occurred, and institution of appropriate antibiotic therapy will probably be too late.
We have carried out a long-term study on the patterns of the development of the enteric microflora in preterm neonates at high risk for NEC. Our data suggest that early appearance of C perfringens in the feces of low-birth-weight, preterm infants may predict NEC.2
Although C perfringens appears early in the full-term infant's stool (depending on feed composition),3 colonization patterns in preterm infants differ,4 and therefore recognition of C perfringens in the feces provides a valuable marker for contamination. Furthermore, timing of colonization with C perfringens during the first 2 weeks