Historically, most of the acute complications of prematurity have occurred in the neonatal intensive care unit, not in the Emergency Department (ED). It is becoming increasingly common, however, for premature infants to be discharged from the hospital before they have reached a postconceptual age of 40 weeks. Such infants remain at relatively increased risk for a variety of complications of prematurity and may present to the ED in their first month of life. To highlight its symptomatology and review its management, we present the case of an infant presenting back to the ED with coffee ground emesis and fulminant necrotizing enterocolitis.