What laboratory data should trump the bedside diagnosis?
Stool pathogens, particularly enteral viruses should strongly influence the diagnosis of ANID and should be used to revise bedside decisions when appropriate. In general, stool cultures are typically not sent in an NEC work-up and this is a trend that needs to be reversed. Blood pathogens must be taken in context with the bedside data because the reality is that gastroenteric illnesses compromise host defenses and allow enteric flora to act as systemic pathogens. For example, enterobacterium in the blood is highly consistent with NEC if the patient has had pharmacologic inhibition of stomach acid production and has pneumatosis on X-rays.68 Conversely, if 3 days later, the same 900 g infant grows out rotavirus from bloody stools that were collected at the presentation of illness, then the etiology is much more likely to be from VEI. We would add that such an infant is likely to be quite ill and, from a clinical perspective, management will be much the same regardless of the actual diagn
