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Neonatal necrotizing enterocolitis: a case series examining clinical diagnosis with discrepant versus concordant autopsy results

Abstract

Objective

The objective of this study is to determine whether rapidity of death in necrotizing enterocolitis (NEC) increased odds of discordance between clinical and pathological diagnosis.

Study design

Retrospective case-series study including preterm infants admitted to the NICU.

Results

Twenty-two infants met the selection criteria. Gross pathologic evidence of NEC was present in 1/6 cases (17%) where demise occurred <12 h after onset of symptoms, 3/5 cases (60%) within 12–24 h, and 8/11 cases (73%) in >24 h. Histological evidence of necrosis was present in 4/6 (67%) cases when death occurred <12 h, 4/5 (80%) in 12–24 h, and 9/11 (82%) in >24 h. The percentage with gross pathologic evidence showed a monotonic trend (P = 0.031), while the trend was less clear for histologic findings (P = 0.496).

Conclusion

Pathologic features of cell death may not have had sufficient time to develop. This study could reassure both healthcare providers and families when pathologic and clinical diagnoses are not consistent.

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Acknowledgements

The Laboratory Medical and Scientific Partnership at the Children’s Hospital of Eastern Ontario provided support to offset the operational costs of report and chart retrieval.

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Correspondence to Emanuela Ferretti.

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Lawrence, S.L., Grynspan, D., Chan, M. et al. Neonatal necrotizing enterocolitis: a case series examining clinical diagnosis with discrepant versus concordant autopsy results. J Perinatol 40, 928–934 (2020). https://doi.org/10.1038/s41372-020-0611-7

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