Necrotizing entercolitis: socio-demographic, clinical and histopathological findings in a series of neonatal autopsies
Abstract
Introduction. Necrotizing entercolitis is a disorder characterized by the ischemic necrosis of intestinal mucosa. It is the most serious gastrointestinal disease affecting neonates, with high morbidity and mortality rates, mainly among premature newborns. The purpose of this study is to describe the clinical and anatamo-pathological characteristics of deceased newborns with necrotizing entercolitis, diagnosed at a high-complexity hospital. Methodology. This is a descriptive retrospective study of 21 cases of medical-scientific autopsies performed at a high-complexity hospital in northeastern Colombia, with anatomo-pathological findings of necrotizing entercolitis, performed between January 2013 and July 2017. Results. 85.7% of the newborns were pre-term, and the same percentage had weight at birth below 2.5 kilograms. Regarding the mothers’ background, 14.3% displayed a spectrum of hypertensive disorders associated with pregnancy, and 23.8% had maternal infections. The three most frequent locations of necrotizing entercolitis were the ileum, ascending colon and transverse colon. Discussion. According to some authors, up to 85% of all cases of necrotizing entercolitis occur in premature patients, especially in babies with extremely low weight at birth. There are forms of necrotizing entercolitis that occur in full term babies, and they are generally associated with contributing factors, which is consistent with the findings of this study. Conclusions. This study of a Colombian population is consistent with other descriptions of the global population, where necrotizing entercolitis arises more frequently in pre-term newborns and low weight at birth.
References
Stafford IA, Rodrigue E, Berra A, Adams W, Heard AJ, Hagan JL, et al. The strong correlation between neonatal early-onset Group B Streptococcal disease and necrotizing enterocolitis. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2018;223,93-97. doi: 10.1016/j.ejogrb.2018.02.024.
Samuels N, Van-De-Graaf RA, De-Jonge RCJ, Reiss IKM, Vermeulen MJ. Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC Pediatrics. 2017;17(1):105. doi:10.1186/s12887-017-0847-3.
Neu J, Walker WA. Necrotizing Enterocolitis. The New England Journal of Medicine. 2011;364:255-64. doi:10.1056/nejmra1005408.
Moschopoulos C, Kratimenos P, Koutroulis I, Shah BV, Mowes A, Bhandari V. Review Article The Neurodevelopmental Perspective of Surgical Necrotizing Enterocolitis: The Role of the Gut-Brain Axis. Mediators of Inflammation. 2018:1-8. doi:10.1155/2018/7456857.
Zani A, Pierro A. Necrotizing enterocolitis: controversies and challenges. F1000Research. 2015. doi:10.12688/f1000research.6888.1.
Feldens L, Souza JCK, Fraga JC. There is an association between disease location and gestational age at birth in newborns submitted to surgery due to necrotizing enterocolitis. Jornal de Pediatria. 2018;94(3):320-324. doi:10.1016/j.jped.2017.06.010.
Aceti A, Beghetti I, Martini S, Faldella G, Corvaglia L. Review Article Oxidative Stress and Necrotizing Enterocolitis: Pathogenetic Mechanisms, Opportunities for Intervention, and Role of Human Milk. Oxidative Medicine and Cellular Longevity. 2018:1-7. doi:10.1155/2018/7397659.
Yang CC, Tang PL, Liu PY, Huang WC, Chen YY, Wang H, et al. Maternal pregnancy-induced hypertension increases subsequent neonatal necrotizing enterocolitis risk. Medicine. 2018;97(31): e11739. doi:10.1097/MD.0000000000011739.
Mutanen A, Pierro A, Zani A. Perioperative Complications Following Surgery for Necrotizing Enterocolitis. European Journal of Pediatric Surgery. 2018;28(2):148-151. doi:10.1055/s-0038-1636943.
Szpecht D, Neumann-Klimasińska N, Błaszczyński M, Seremak-Mrozikiewicz A, Kurzawińska G, Cygan D, et al. Candidate gene analysis in pathogenesis of surgically and non-surgically treated necrotizing enterocolitis in preterm infants. Molecular and Cellular Biochemistry. 2018;439(1-2):53-63. doi:10.1007/s11010-017-3135-5.
Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. Journal of Pediatric Surgery. 2010; 45(7): 1391–1397. doi:10.1016/j.jpedsurg. 2009.12.002.
Lu Q, Cheng S, Zhou M, Yu J. Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study. Pediatrics & Neonatology. 2017;58(2):165-170. doi:10.1016/j.pedneo.2016.04.002.
Mϋller MJ, Paul T, Seeliger S. Necrotizing enterocolitis in premature infants and newborns. Journal of Neonatal-Perinatal Medicine. 2016;16;9(3):233-42. doi:10.3233/NPM-16915130.
Equipo Maternidad Segura Subdirección de Prevención, Vigilancia y Control en Salud Pública Instituto Nacional de Salud. Mortalidad Perinatal y Neonatal Tardía. Protocolo de vigilancia en salud pública. 2017:1-31p
Denning TL, Bhatia AM, Kane AF, Patel RM, Denning PW. Pathogenesis of NEC: Role of the innate and adaptive immune response. Seminars in Perinatology. 2017; 41(1):15-28. doi: 10.1053/j.semperi.2016.09.014.
Hackam D, Caplan M. Necrotizing enterocolitis: Pathophysiology from a historical context. Seminars in Pediatric Surgery.2018; 27(1):11-8 doi:10.1053/j.sempedsurg.2017.11.003.
Lau PE, Cruz SM, Ocampo EC, Nuthakki S, Style CC, Lee TC, et al. Necrotizing enterocolitis in patients with congenital heart disease: A single center experience. Journal of Pediatric Surgery. 2018;53(5):914-917. doi: 10.1016/j.jpedsurg.2018.02.014.
Duci M, Fascetti F, Marta L, Elena E, Maria P, Cavicchiolo E, et al. Neonatal independent predictors of severe NEC. Pediatric Surgery International. 2018;34(6):663-669. doi:10.1007/s00383-018-4261-1.
Lopez NL, Gowda C, Backes CH, Nandi D, Rn HM, Fichtner S, et al. Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis. Congenital Heart Disease. 2018;13(4):512-518. doi:10.1111/chd.12602.
Agnoni A, Lazaros-Amendola C. Necrotizing enterocolitis: Current concepts in practice. Journal of the American Academy of Physician Assistants. 2017;30(8):16-21. doi:10.1097/01.JAA.0000521131.85173.f9.
Caplan MS, Fanaroff A. Necrotizing: A historical perspective. Seminars in Perinatology. 2017;41(1):2-6. doi:10.1053/j.semperi.2016.09.012.
Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatrics in Review. 2017;38(12):552-559. doi:10.1542/pir.2017-0002.
Watchko JF. Bilirubin-Induced Neurotoxicity in the Preterm Neonate. Clinics in Perinatology. 2016;43(2):297-311.doi: 10.1016/j.clp.2016.01.007.
Watchko JF, Maisels MJ. The enigma of low bilirubin kernicterus in premature infants: why does it still occur, and is it preventable? Seminars in Perinatology. 2014;38(7):397-406. doi:10.1053/j.semperi.2014.08.002.
Perger L, Mukhopadhyay D, Komidar L, Wiggins-Dohlvik K, Uddin MN, Beeram M. Maternal pre-eclampsia as a risk factor for necrotizing enterocolitis. The Journal of Maternal-Fetal & Neonatal Medicine. 2016;29(13):2098-103. doi:10.3109/14767058.2015.1076386.
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