Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical necrotizing enterocolitis

• Published in: Journal of perinatology Vol. 35; no. 9; pp. 755 - 762
• Main Authors: Remon, J I, Amin, S C, Mehendale, S R, Rao, R, Luciano, A A, Garzon, S A, Maheshwari, A
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-09-2015; Nature Publishing Group
• Subjects: 692/699/1503; Analysis; Autopsies; Autopsy; Bacteria; Bacteria - isolation & purification; Bacterial Load - methods; Care and treatment; Confidence intervals; Digestive System Surgical Procedures - methods; Enterocolitis; Enterocolitis, Necrotizing - mortality; Enterocolitis, Necrotizing - pathology; Enterocolitis, Necrotizing - surgery; Enterocolitis, Neonatal necrotizing; Enterocolitis, Pseudomembranous; Female; Gastrointestinal diseases; Gestational Age; Health aspects; Humans; Infant; Infant, Newborn; Infant, Very Low Birth Weight; Infants; Infants (Premature); Inflammation; Intestine; Intestines - microbiology; Intestines - pathology; Male; Medical records; Medicine; Medicine & Public Health; Mortality; Necrosis; Necrotizing enterocolitis; original-article; Pathology; Patient outcomes; Pediatric Surgery; Pediatrics; Predictive Value of Tests; Prognosis; Risk factors; Tissues; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2015.51

Objective:
Up to a third of all infants who develop necrotizing enterocolitis (NEC) require surgical resection of necrotic bowel. We hypothesized that the histopathological findings in surgically resected bowel can predict the clinical outcome of these infants.
Study Design:
We reviewed the medical records and archived pathology specimens from all patients who underwent bowel resection/autopsy for NEC at a regional referral center over a 10-year period. Pathology specimens were graded for the depth and severity of necrosis, inflammation, bacteria invasion and pneumatosis, and histopathological findings were correlated with clinical outcomes.
Result:
We performed clinico-pathological analysis on 33 infants with confirmed NEC, of which 18 (54.5%) died. Depth of bacterial invasion in resected intestinal tissue predicted death from NEC (odds ratio 5.39 per unit change in the depth of bacterial invasion, 95% confidence interval 1.33 to 21.73). The presence of transmural necrosis and bacteria in the surgical margins of resected bowel was also associated with increased mortality.
Conclusion:
Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical NEC.