Which among the following is not included in the triad of necrotizing enterocolitis

Necrotising Enterocolitis:- * Most common life-threatening emergency of the gastrointestinal tract in the newborn period * The distal pa of the ileum and the proximal segment of colon are involved most frequently * The greatest risk factor for NEC is prematurity. NEC can occur secondary to bih asphyxia, Down syndrome, congenital hea disease, rotavirus infections, and Hirschsprung disease, red cells transfusion * Coagulation necrosis is the characteristic histologic finding in intestinal specimen. * Common pathogens causing NNEC include Escherichia coli, Klebsiella, Clostridium perfringens, Staphylococcus epidermidis, astrovirus, norovirus, and rotavirus. * Aggressive enteral feeding may predispose to the development of NEC * The onset of NEC is usually in the 2nd or 3rd wk of life but can be as late as 3 months in VLBW infants. * Pneumatosis intestinalis (air in the bowel wall) is diagnostic Triad of Necrotising Enterocolitis Includes: - * Thrombocytopenia * Metabolic Acidosis * Refractory Hyponatremia Ref:- Nelson 20th Edition; Pg num:- 870,871