Abstract
<i>Sir</i>.—Warren et al<sup>1</sup>suggest that massive hemolysis in the newborn with necrotizing enterocolitis (NEC) may be due to<i>Clostridium perfringens</i>infection. In our experience, by the time massive hemolysis is manifest, systemic spread of<i>C perfringens</i>, 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<i>C perfringens</i>in the feces of low-birth-weight, preterm infants may predict NEC.<sup>2</sup> Although C<i>perfringens</i>appears early in the full-term infant's stool (depending on feed composition),<sup>3</sup>colonization patterns in preterm infants differ,<sup>4</sup>and therefore recognition of<i>C perfringens</i>in the feces provides a valuable marker for contamination. Furthermore, timing of colonization with<i>C perfringens</i>during the first 2 weeks
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