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.
Retrospective case-series study including preterm infants admitted to the NICU.
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).
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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Nino DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016;13:590–600.
Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2018;103:F182–9.
Yee WH, Soraisham AS, Shaw VS, Aziz K, Yoon W, Lee SK. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 2012;129:e298–304.
Gephart SM, Gordon PV, Penn AH, Gregory KE, Swanson JR, Maheshwari A, et al. Changing the paradigm of defining, detecting, and diagnosing NEC: perspectives on Bell’s stages and biomarkers for NEC. Semin Pediatr Surg. 2018;27:3–10.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.
Ji J, Ling XB, Zhao Y, Hu Z, Zheng X, Xu Z, et al. A data-driven algorithm integrating clinical and laboratory features for the diagnosis and prognosis of necrotizing enterocolitis. PLoS ONE. 2014;9:e89860. Available from https://www.ncbi.nlm.nih.gov/pubmed/24587080 full 10.137/journal.pone.0089860.
Ballance WA, Dahms BB, Shenker N, Kliegman RM, et al. Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr. 1990;117:S6–S13.
Challis P, Larsson L, Sjostrom ES, Serenius F, Domellof M, Elfvin A. Validation of the diagnosis of necrotizing enterocolitis in a Swedish population-based observational study. Acta Paediatr. 2019;108:835–41.
Battersby C, Longford N, Costeloe K, Modi N. Development of a gestational age-specific case definition for neonatal necrotizing enterocolitis. JAMA Pediatr. 2017;171:256–63.
Vermont Oxford Network. Vermont Oxford Network Database 2020 Manual of Operations, part 2, Release 24.0. Data definitions and Data forms. https://vtoxford.zendesk.com/hc/en-us/articles/360037047753-2020-Manual-of-Operations-Part-2-Release-24-0-PDF. Published August 2019.
Sho S, Neal MD, Sperry J, Hackam DJ. A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants. J Pediatr Surg. 2014;49:1053–6.
Pasotti M, Prati F, Arbustini E. The pathology of myocardial infarction in the pre- and post-interventional era. Heart. 2006;92:1552–6.
Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clin Perinatol. 2013;40:135–48.
Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008;248:44–51.
Vaughan WG, Grosfeld JL, West K, Sche rerIIILR, Villamizar E, Rescoria FJ. Avoidance of stomas and delayed anastomosis for bowel necrosis: the ‘clip and drop-back’ technique. J Pediatr Surg. 1996;31:542–5.
Gordon PV, Clark R, Swanson JR, Spitzer A. Can a national dataset generate a nomogram for necrotizing enterocolitis onset? J Perinatol. 2014;34:732–5.
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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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