PICTURE OF THE MONTH Indian Journal of Pediatrics https://doi.org/10.1007/s12098-023-04548-2 Declarations Conflict of Interest None. References 1. Abbo O, Harper L, Michel JL, Ramful D, Breden A, Sauvat F. Necrotizing enterocolitis in full term neonates: is there always an underlying cause? J Neonatal Surg. 2013;2:29. 2. Clarke AJ, Sibert JR. Hypernatraemic dehydration and necrotiz- ing enterocolitis. Postgrad Med J. 1985;61:65–6. 3. Soni R, Katana A, Curry JI, Humphries PD, Huertas-Ceballos A. How to use abdominal X-rays in preterm infants suspected of developing necrotising enterocolitis. Arch Dis Child Educ Pract Ed. 2020;105:50–7. Publisher’s Note Springer Nature remains neutral with regard to juris- dictional claims in published maps and institutional affiliations. An 18-d-old term baby presented with complaints of vomit- ing and refusal of feeds for 2 d. He was fed predominantly cow’s milk and formula from birth. At admission baby was in shock with dehydration (admission weight of 2550 g against birthweight of 2800 g). Fluid resuscitation for hypernatremic dehydration (serum Na – 155 mEq/L) and antibiotics were started but baby developed rapidly worsen- ing abdominal distension and refractory shock with multi- organ dysfunction in the form of acute kidney injury and gastrointestinal bleeding. Abdominal radiograph showed dilated bowel loops with extensive pneumatosis intestina- lis and portal venous gas (PVG) (Fig. 1). Surgical interven- tion was planned but the baby had persistent deterioration despite resuscitative measures and expired within a few hours of admission. Necrotising enterocolitis (NEC) is usually a disorder of prematurity, but can present in term infants with risk factors like congenital heart disease, poly- cythemia, small-for-gestational age (SGA), formula feeding and infections [1]. The cause of NEC in this case is prob- ably due to formula/cow’s milk feeding with hypernatremic dehydration [2], as heart disease was ruled out. Pathogno- monic X-ray findings of pneumatosis intestinalis, soap-bub- ble appearance and portal venous gas are associated with a poorer prognosis [3]. The X-ray findings are commonly seen in preterm infants with NEC but extensive pneuma- tosis and PVG are very rare in term infants with NEC [3].  Ambalakkuthan Murugesan murugesan89@gmail.com 1 Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India 2 Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India Received: 25 January 2023 / Accepted: 1 March 2023 © The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation 2023 Extensive Pneumatosis Intestinalis in a Term Neonate Ramge Ramachandran Sivakumar 1  · Ambalakkuthan Murugesan 2  · Praachi Singh 2  · Revati Deglurkar 2 Fig. 1 X-ray abdomen showing (a) portal venous gas, (b) widespread pneumatosis intestinalis and dilated bowel loops 1 3