Objective To examine circulating levels of inter-alpha inhibitor protein (IaIp) in infants with necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP) and matched controls in order to assess the diagnostic accuracy of IaIp to differentiate NEC from SIP; and to compare receiver operating characteristics (ROC) of IaIp for NEC with C-reactive protein (CRP). Study design A p rospective, nested case control study of infants with feeding intolerance was carried out. Blood and clinical data were collected from 27 infants diagnosed with NEC or SIP and from 26 matched controls admitted to our unit. Infants with modified Bell's criteria stage 2 or higher were included as NEC. Clinical, radiological and/or surgical findings were used to identify infants with SIP. Controls were matched for gestational age, postnatal age, sex, and birth weight. Results Mean±SD IaIp blood levels were 147±38 mg/L, 276±67 mg/L and 330±100 mg/L in infants with NEC, SIP and matched controls, respectively (P<0.004 and P<0.01). ROC analysis to establish the predictive value of NEC demonstrated areas under curve of 0.98 and 0.63 for IaIp and CRP, respectively. Conclusions IaIp levels were significantly decreased in infants with NEC compared with SIP and matched controls. The diagnostic accuracy of IaIp for NEC was superior to that of CRP.

Massive perivillous fibrinoid deposition is a rare placental pathology associated with significant adverse pregnancy outcome and can recur. We provide a detailed case review of a woman through 10 of her pregnancies, including 8 consecutive pregnancy losses and 2 live births. We also conducted a retrospective chart review of all massive perivillous fibrinoid deposition placenta specimens at our institution over an eight-year period. A total of 42 cases of massive perivillous fibrinoid deposition were identified from 2007 to 2015, yielding an incidence of 0.16%. Recurrence was seen in subsequent pregnancy in eight out of nine (88.9%) cases with more than one specimen. The clinical characteristics, perinatal outcomes and α-feto protein level of the 42 cases are presented. Also, presented is a review of the literature discussing placental pathology, pathogenetic mechanisms and management of this condition.

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