Which clinical finding is diagnostic of necrotizing enterocolitis?

Pneumatosis intestinalis is considered a classic and diagnostic radiological finding in necrotizing enterocolitis (NEC). It refers to the presence of gas within the bowel wall, which is indicative of compromised intestinal integrity and the potential for bowel necrosis. This condition typically arises in preterm infants and is characterized by severe intestinal inflammation, often leading to tissue death. The presence of pneumatosis intestinalis suggests that significant damage has occurred, making it a critical diagnostic feature when evaluating suspected cases of NEC.

In contrast, while intestinal hemorrhage may occur in NEC, it is not specific enough to serve as a definitive diagnostic criterion. Abdominal tenderness can be a general sign of many gastrointestinal issues and does not uniquely point to necrotizing enterocolitis. High fevers may accompany various infections and conditions, including NEC, but they lack the specificity required for diagnosis. Thus, pneumatosis intestinalis stands out as the definitive clinical finding for diagnosing necrotizing enterocolitis.