Clinical determinants and impact of hemorrhagic lesions on intestinal pathology in preterm infants with surgical necrotizing enterocolitis

Abstract

OBJECTIVE: We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC). METHODS: A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology. RESULTS: The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 % ; p = 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p = 0.034), lost more bowel length (p = 0.045), had higher CRP levels at 2 weeks (p = 0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; p = 0.014) than mild/moderate (Grade 0–2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; p = <0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; p = 0.037), higher neovascularization (p = 0.01), higher fibroblasts (p = 0.023) and higher lymphocyte percentages up to 48 hours (p < 0.05) following NEC than mild/ moderate hemorrhage group. On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05–0.58]; p = 0.005), higher inflammation (OR 3.7 [95% CI 2.09–7.32]; p = 0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02–1.11]; p = 0.005) were independently associated with a higher odd of severe intestinal hemorrhage. CONCLUSION: The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling.

Clinical and Growth Correlates of Retinopathy of Prematurity in Preterm Infants with Surgical Necrotizing Enterocolitis and Intestinal Perforation

“…Necrotizing enterocolitis is associated with necrosis, inflammation, hemorrhage, and reparative changes on intestinal histopathological examination [4]. The hemorrhagic necrosis seen in infants with NEC is likely due to abnormal vasculature and neoangiogenesis in the intestine [5,6]. The retinopathy of prematurity is also associated with abnormal vascularization secondary to insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) mediated effects on retinal angiogenesis [7].…”

“…4 The hemorrhagic necrosis seen in infants with NEC is likely due to abnormal vasculature and neoangiogenesis in the intestine. 5,6 The retinopathy of prematurity (ROP) is also associated with abnormal vascularization secondary to insulin-like growth factor 1 (IGF-1)-and vascular endothelial growth factor (VEGF)mediated effects on retinal angiogenesis. 7 In the Early Treatment for Retinopathy of Prematurity study, ROP developed in 68% of preterm infants < 1,251 g, and severe ROP developed in almost 37% of those cases.…”

Clinical and Growth Correlates of Retinopathy of Prematurity in Preterm infants with Surgical Necrotizing Enterocolitis and intestinal Perforation

“…Necrotizing enterocolitis is associated with necrosis, in ammation, hemorrhage and reparative changes on intestinal histopathological examination [3]. The hemorrhagic necrosis seen in infants with NEC is most likely due to anormal vasculature and neo angiogenesis in the intestine [4,5]. The Retinopathy of prematurity is also associated with abnormal vascularization because of insulin like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) effect on the retinal angiogenesis [6].…”