Abstract
Objective
The objective of this study is to determine whether rapidity of death in necrotizing enterocolitis (NEC) increased odds of discordance between clinical and pathological diagnosis.
Study design
Retrospective case-series study including preterm infants admitted to the NICU.
Results
Twenty-two infants met the selection criteria. Gross pathologic evidence of NEC was present in 1/6 cases (17%) where demise occurred <12 h after onset of symptoms, 3/5 cases (60%) within 12–24 h, and 8/11 cases (73%) in >24 h. Histological evidence of necrosis was present in 4/6 (67%) cases when death occurred <12 h, 4/5 (80%) in 12–24 h, and 9/11 (82%) in >24 h. The percentage with gross pathologic evidence showed a monotonic trend (P = 0.031), while the trend was less clear for histologic findings (P = 0.496).
Conclusion
Pathologic features of cell death may not have had sufficient time to develop. This study could reassure both healthcare providers and families when pathologic and clinical diagnoses are not consistent.
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References
Nino DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016;13:590–600.
Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2018;103:F182–9.
Yee WH, Soraisham AS, Shaw VS, Aziz K, Yoon W, Lee SK. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 2012;129:e298–304.
Gephart SM, Gordon PV, Penn AH, Gregory KE, Swanson JR, Maheshwari A, et al. Changing the paradigm of defining, detecting, and diagnosing NEC: perspectives on Bell’s stages and biomarkers for NEC. Semin Pediatr Surg. 2018;27:3–10.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.
Ji J, Ling XB, Zhao Y, Hu Z, Zheng X, Xu Z, et al. A data-driven algorithm integrating clinical and laboratory features for the diagnosis and prognosis of necrotizing enterocolitis. PLoS ONE. 2014;9:e89860. Available from https://www.ncbi.nlm.nih.gov/pubmed/24587080 full 10.137/journal.pone.0089860.
Ballance WA, Dahms BB, Shenker N, Kliegman RM, et al. Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr. 1990;117:S6–S13.
Challis P, Larsson L, Sjostrom ES, Serenius F, Domellof M, Elfvin A. Validation of the diagnosis of necrotizing enterocolitis in a Swedish population-based observational study. Acta Paediatr. 2019;108:835–41.
Battersby C, Longford N, Costeloe K, Modi N. Development of a gestational age-specific case definition for neonatal necrotizing enterocolitis. JAMA Pediatr. 2017;171:256–63.
Vermont Oxford Network. Vermont Oxford Network Database 2020 Manual of Operations, part 2, Release 24.0. Data definitions and Data forms. https://vtoxford.zendesk.com/hc/en-us/articles/360037047753-2020-Manual-of-Operations-Part-2-Release-24-0-PDF. Published August 2019.
Sho S, Neal MD, Sperry J, Hackam DJ. A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants. J Pediatr Surg. 2014;49:1053–6.
Pasotti M, Prati F, Arbustini E. The pathology of myocardial infarction in the pre- and post-interventional era. Heart. 2006;92:1552–6.
Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clin Perinatol. 2013;40:135–48.
Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008;248:44–51.
Vaughan WG, Grosfeld JL, West K, Sche rerIIILR, Villamizar E, Rescoria FJ. Avoidance of stomas and delayed anastomosis for bowel necrosis: the ‘clip and drop-back’ technique. J Pediatr Surg. 1996;31:542–5.
Gordon PV, Clark R, Swanson JR, Spitzer A. Can a national dataset generate a nomogram for necrotizing enterocolitis onset? J Perinatol. 2014;34:732–5.
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The Laboratory Medical and Scientific Partnership at the Children’s Hospital of Eastern Ontario provided support to offset the operational costs of report and chart retrieval.
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Lawrence, S.L., Grynspan, D., Chan, M. et al. Neonatal necrotizing enterocolitis: a case series examining clinical diagnosis with discrepant versus concordant autopsy results. J Perinatol 40, 928–934 (2020). https://doi.org/10.1038/s41372-020-0611-7
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DOI: https://doi.org/10.1038/s41372-020-0611-7