Isolated gastric pneumatosis in neonates is extremely rare and usually associated with necrotizing enterocolitis (NEC) or obstruction of the proximal gastrointestinal tract. Although similar radiographically, gastric pneumatosis secondary to NEC is typically a marker of fulminant disease that carries a poor prognosis while gastric pneumatosis from proximal obstruction follows a more benign course after relief of the obstruction. This case describes an extremely low birth weight premature neonate treated with postnatal steroids who developed isolated gastric pneumatosis without evidence of intestinal obstruction.