Abstract
OBJECTIVE:
Necrotizing enterocolitis (NEC) is a common and serious gastrointestinal disorder that predominately affects premature infants. Few prognostic indices are available to guide physicians through the expected course of the disease. We hypothesized that the degree and timing of onset of severe thrombocytopenia (platelet count <100,000/mm3) would be a predictor of adverse outcome and an indication for surgical intervention in infants with NEC.
STUDY DESIGN:
The clinical presentation and outcome of all infants with Bell stage II or III NEC treated at Texas Children's Hospital between 1997 and 2001 were retrospectively reviewed. Patients were stratified into two groups based on the presence (Group1) or absence (Group 2) of severe thrombocytopenia (platelet count <100,000/mm3) within 3 days of a diagnosis of NEC. Differences between groups were compared using logistic regression to estimate adjusted odds ratios.
RESULTS:
A total of 91 infants met inclusion criteria (average birth weight 1288±135 g; average gestational age 29.0±3.0 weeks). Compared to infants in Group 2, infants in Group 1 were more premature (28.0±4.1 vs 30.0±4.2 weeks; p=0.02), more likely to have received postnatal steroids (42.5% vs 20.4%; p=0.02), and more likely to require laparotomy for gangrenous bowel (adjusted OR 16.33; p<0. 001). The presence of severe thrombocytopenia was also a predictor of mortality (adjusted OR 6.39; p=0.002) and NEC-related gastrointestinal complications including cholestatic liver disease and short bowel syndrome (adjusted OR 5.47; p=0.006).
CONCLUSION:
Severe thrombocytopenia within the first 3 days after a diagnosis of NEC suggests a higher likelihood of bowel gangrene, morbidity, and mortality. Prospective studies of infants with early and severe thrombocytopenia may help determine the optimal timing of laparotomy in infants with NEC.
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References
Griffiths DM, Forbes DA . Primary anastamosis for necrotizing enterocolitis: a 12 year experience. J Pediatr Surg 1989;24:515–518.
McCormack CJ, Emmens RW, Putnam TC . Evaluation of factors in high risk neonatal necrotizing enterocolitis. J Pediatr Surg 1987;22:488–491.
Rowe MI, Reblock KK, Kurkchubasche AG, Healey PJ . Necrotizing enterocolitis in the extremely low-birth-weight infant. J Pediatr Surg 1994;29:987–991.
Morecroft JA, Spitz L, Hamilton PA, Holmes SJK . Necrotizing enterocolitis–multisystem organ failure of the newborn. Acta Paediatr Suppl 1994;396:21–23.
Horwitz JR, Lally KP, Cheu HW, Vazquez WD, Grosfeld JL, Ziegler MM . Complications after surgical intervention for necrotizing enterocolitis: a multicenter review. J Pediatr Surg 1995;30:994–999.
Fasoli L, Turi RA, Spitz L, Kiely EM, Drake D, Pierro A . Necrotizing enterocolitis: extent of disease and surgical treatment. J Pediatr Surg 1999;34:1096–1099.
Chwals WJ, Blakely ML, Cheng A, et al. Surgery-associated complications in necrotizing enterocolitis: a multiinstitutional study. J Pediatr Surg 2001;36:1722–1724.
Ehrlich PF, Sato TT, Short BL, Hartman GE . Outcome of perforated necrotizing enterocolitis in the very-low-birth-weight neonate may be independent of the type of surgical treatment. Am Surgeon 2001;67:752–756.
Camberos A, Patel K, Applebaum H . Laparotomy in very small premature infants with necrotizing enterocolitis or focal intestinal perforation: postoperative outcome. J Pediatr Surg 2002;37:1692–1695.
Radhakrishnan J, Blechman B, Shrader C, Patel MK, Mangurten HH, McFadden JC . Colonic strictures following successful medical management of necrotizing enterocolitis: a prospective study evaluating early gastrointestinal contrast studies. J Pediatr Surg 1991;26:1043–1046.
Ricketts RR, Jerles ML . Neonatal necrotizing enterocolitis: experience with 100 consecutive surgical patients. World J Surg 1990;14:600–605.
Schimpl G, Hollwarth ME, Fotter R, Becker H . Late intestinal strictures following successful treatment of necrotizing enterocolitis. Acta Paediatr Suppl 1994;396:80–83.
Gollin G, Abarbanell A, Baerg JE . Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants. J Pediatr Surg 2003;38:814–817.
Moss RL, Das JB, Raffensperger JG . Necrotizing enterocolitis and total parenteral nutrition-associated cholestasis. Nutrition 1996;12:340–343.
Simon NP . Follow-up for infants with necrotizing enterocolitis. Clin Perinat 1994;21:411–424.
Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1–7.
O'Neill JA . Neonatal necrotizing enterocolitis. Surg Clin N Am 1981;61:1013–1022.
Touloukian RJ . Neonatal necrotizing enterocolitis: an update on etiology, diagnosis, and treatment. Surg Clin N Am 1976;56:281–298.
Cikrit D, Mastandrea J, West KW, Schreiner RL, Grosfeld JL . Necrotizing enterocolitis: factors affecting mortality in 101 surgical cases. Surgery 1984;96:648–653.
Engum SA, Grosfeld JL . Necrotizing enterocolitis. Curr Opin Pediatr 1998;10:123–130.
Molik KA, West KW, Rescorla FJ, Scherer LR, Engum SA, Grosfeld JL . Portal venous air: the poor prognosis persists. J Pediatr Surg 2001;36:1143–1145.
Kosloske AM, Papile L-A, Burstein J . Indications for operation in acute necrotizing enterocolitis of the neonate. Surgery 1980;87:502–508.
Cikrit D, Mastandrea J, Grosfeld JL, West KW, Schreiner RL . Significance of portal venous air in necrotizing enterocolitis: analysis of 53 cases. J Pediatr Surg 1985;20:425–430.
Hutter JJ, Hathaway WE, Wayne ER . Hematologic abnormalities in severe neonatal necrotizing enterocolitis. J Pediatr 1976;88:1026–1031.
Patel CC . Hematologic abnormalities in acute necrotizing enterocolitis. Pediatr Clin N Am 1977;24:579–584.
Mehta P, Vasa R, Neumann L, Karpatkin M . Thrombocytopenia in the high-risk infant. J Pediatrics 1980;97:791–794.
Kosloske AM . Indications for operation in necrotizing enterocolitis revisited. J Pediatr Surg 1994;29:663–666.
Ververidis M, Kiely EM, Spitz L, Drake DP, Eaton S, Pierro A . The clinical significance of thrombocytopenia in neonates with necrotizing enterocolitis. J Pediatr Surg 2001;36:799–803.
Ragazzi S, Pierro A, Peters M, Fasoli L, Eaton S . Early full blood count and severity of disease in neonates with necrotizing enterocolitis. Pediatr Surg Int 2003;19:376–379.
Kling PJ, Hutter JJ . Hematologic abnormalities in severe neonatal necrotizing enterocolitis: 25 years later. J Perinatol 2003;23:523–530.
Cass DL, Brandt ML, Patel DL, Nuchtern JG, Minifee PK, Wesson DE . Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000;35:1531–1536.
Banieghbal B, Schoeman L, Kalik F, da Fonseca JM, Davies MR . Surgical indications and strategies for necrotizing enterocolitis in low income countries. World J Surg 2002;26:444–447.
Kurscheid Th, Holschneider AM . Necrotizing enterocolitis (NEC) — mortality and long-term results. Eur J Pediatr Surg 1993;3:139–143.
Dimmitt RA, Meier AH, Skarsgard ED, Halamek LP, Smith BM, Moss RL . Salvage laparotomy for failure of peritoneal drainage in necrotizing enterocolitis in infants with extremely low-birth-weight. J Pediatr Surg 2000;35:856–859.
Morgan LJ, Shochat SJ, Hartman GE . Peritoneal drainage as primary management of perforated NEC in the very-low-birth-weight infant. J Pediatr Surg 1994;29:310–315.
Ein SH, Shandling B, Wesson D, Filler RM . A 13 year experience with peritoneal drainage under local anesthesia for necrotizing enterocolitis perforation. J Pediatr Surg 1990;25:1034–1037.
Azarow KS, Ein SH, Shandling B, Wesson D, Superina R, Filler RM . Laparotomy or drain for perforated necrotizing enterocolitis: who gets what and why? Pediatr Surg Int 1997;12:137–139.
Rovin JD, Rodgers BM, Burns RC, McGahren, ED . The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis. J Pediatr Surg 1999;34:143–147.
Lessin MS, Luks FI, Wesselhoeft CW, Gilchrist BF, Lannitti D, DeLuca FG . Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low-birth-weight (<750 g). J Pediatric Surg 1998;33:370–372.
Moss LR, Dimmit RA, Henry MCW, Geraghty N, Efron B . A meta-analysis of peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis. J Pediatr Surg 2001;36:1210–1213.
Hanahan DJ . Platelet activating factor: a biologically active phosphoglyceride. Ann Rev Biochem 1986;55:483–509.
Snyder F . Platelet-activating factor and related acetylated lipids as potent biologically active cellular mediators. Am J Phys 1990;259:C697–C708.
Denizot Y, Dassa E, Benveniste J, Thomas Y . PAF-acether production by Escherichia coli. Biochem Biophys Res Commum 1989;161:939–943.
Stohlawetz P, Folman CC, Borne A, et al. Effects of endotoxemia on thrombopoiesis in men. Thromb Haemost 1999;81:613–617.
Caplan M, Sun XM, Hsueh W . Hypoxia causes ischemic bowel necrosis in rats: the role of platelet activating factor (PAF-Acether). Gastroenterology 1990;99:979–986.
Zhang C, Hsueh W, Caplan MS, KellyA . Platelet activating factor-induced shock and intestinal necrosis in the rat: role of endogenous platelet activating factor and effect of saline infusion. Crit Care Med 1991;19:1067–1072.
Hsueh W, Caplan MS, Qu XW, Tan X, De Plaen IG, Gonzalez-Crussi F . Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Devel Pathol 2002;6:6–23.
Sun XM, Qu XW, Huang W, Granger DN, Bree M, Hsueh W . Role of leukocyte beta 2-integrin in PAF-induced shock and intestinal injury. Am J Phys 1996;270:G184–G190.
Kubes P, Suzuki M, Granger DN . Platelet activating factor-induced microvascular dysfunction: role of adherent leukocytes. Am J Phys 1990;258:G158–G163.
Kubes P, Afors KE, Granger DN . Platelet activating factor -induced mucosal dysfunction: role of oxidants and granulocytes. Am J Phys 1991;260:G965–G971.
Qu X-W, Rozenfeld RA, Huang W, Bulkley GB, Hsueh W . Role of xanthine oxidase in platelet-activating factor induced intestinal injury in the rat. Gut 1999;44:203–211.
Granger DN . Role of xanthine oxidase and granulocytes in ischemia–reperfusion injury. Am J Phys 1988;255 6 (Part 2):H1269–H1275.
Horbar JD, Badger GJ, Carpenter JH, et al. Trends in mortality and morbidity for very-low-birth-weight infants, 1991–1999. Pediatrics 2002;110:143–151.
De Laet MH, Dassonville M, Johansson A, et al. Small bowel perforation in very-low-birth-weight neonates treated with high-dose dexamethasone. Eur J Pediatr Surg 2000;10:323–327.
Duffy LC, Zielezny MA, Carrion V, et al. Concordance of bacterial cultures with endotoxin and interleukin-6 in necrotizing enterocolitis. Dig Dis Sci 1997;42:359–365.
Isaacs D, North J, Lindsell D, Wilkinson AR . Serum acute phase reactants in necrotizing enterocolitis. Acta Paediatr Scand 1987;76:923–927.
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Kenton, A., O'Donovan, D., Cass, D. et al. Severe Thrombocytopenia Predicts Outcome in Neonates with Necrotizing Enterocolitis. J Perinatol 25, 14–20 (2005). https://doi.org/10.1038/sj.jp.7211180
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DOI: https://doi.org/10.1038/sj.jp.7211180
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