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Clinical utilization of intestinal pathology in the classification of NEC vs SIP cases and prognostication

Journal of Perinatology volume 44, pages 598–599 (2024)Cite this article

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Despite advances in neonatal care, necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) remain leading reasons for surgical intervention, increased morbidity, mortality, and increased economic burden in preterm neonates [1]. Both NEC and SIP have similar clinical management involving drain placement or laparotomy. A recent meta-analysis found that mortality and neurodevelopment outcomes were disparate among the studies of NEC and SIP [2]. Most studies, however, fail to include the histopathological criteria for SIP diagnosis. With gross examination, the diagnosis of NEC or SIP becomes challenging. The lack of histopathological confirmation not only leads to inaccurate diagnoses within the medical record but also errors in the reporting of co-morbidities, clinical associations, and outcomes.

The recent study of 125 infants by Keane et al. [3] investigated the accuracy of preoperative and intraoperative diagnoses compared to the pathologic diagnosis of SIP and NEC. They reported preoperative and intraoperative diagnoses agreement in 90.3%, intraoperative and pathologic agreement in 71.1%, and preoperative and pathologic agreement in 75.2% of patients with a Fleiss’ Kappa of 0.55 (95% CI:0.43,0.68), indicating moderate agreement between the diagnoses. Unfortunately, the authors did not evaluate the individual agreements between the SIP and NEC cases. By comparison, in our recent study [4] of 151 cases, of the 19 cases labeled as SIP by the surgery team, only 3 cases (15%) met histological criteria, indicating poor agreement between the intraoperative and postoperative pathological diagnoses. Likewise, of 132 cases labeled as surgical NEC intraoperatively, 34 (25%) met the pathologic criteria for SIP criteria, and 98 (75%) had the pathologic diagnosis for NEC. These cohort studies demonstrate good agreement between pathological and the preoperative/intraoperative diagnosis when the presumed preoperative diagnosis is NEC. The poor agreement between pathological and preoperative/intraoperative diagnoses observed in SIP cases is of clinical relevance as many such infants require later surgical intervention, raising the risk of systemic morbidity and mortality.

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Acknowledgements

The Mississippi Center for Clinical and Translational Research and the Dept of Pediatrics at Wake Forest School of Medicine for supporting the NEC research.

Funding

Parvesh Garg is partially supported by the NIGMS of the NIH under Award Number U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, NC, USA

    Parvesh Mohan Garg

  2. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA

    Padma P. Garg

  3. Department of Pediatrics/Neonatology, Connecticut Children’s, Hartford, CT, USA

    Jeffrey S. Shenberger

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  1. Parvesh Mohan Garg
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PMG conceptualized the idea. PMG, PPG, and JSS wrote and approved the manuscript.

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Correspondence to Parvesh Mohan Garg.

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Garg, P.M., Garg, P.P. & Shenberger, J.S. Clinical utilization of intestinal pathology in the classification of NEC vs SIP cases and prognostication. J Perinatol 44, 598–599 (2024). https://doi.org/10.1038/s41372-024-01932-4

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