Sir.—I read the report by Cheu et all that supports the claim that breath hydrogen excretion might be useful in the management of the premature neonate at risk for developing necrotizing enterocolitis (NEC). The authors suggest that it is conceivable that many premature infants undergo a period during which their gut represents an environment conducive to rapid bacterial growth. During this critical period NEC will develop if bacteria of sufficient virulence proliferate in a quantity sufficient to overcome the bowel's defenses. The degree to which the balance between bacterial growth and bacterial defenses is upset would then determine the severity of the disease, ranging from no disease or feeding intolerance to mild or fulminant NEC.
They do not, however, acknowledge important observations, helping to further substantiate their interpretation.
Stevenson et al2 showed that the changes in the number of hydrogen-producing bacteria in the gut contributes to changes in