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Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical necrotizing enterocolitis

Journal of Perinatology volume 35, pages 755–762 (2015)Cite this article

Subjects

Abstract

Objective:

Up to a third of all infants who develop necrotizing enterocolitis (NEC) require surgical resection of necrotic bowel. We hypothesized that the histopathological findings in surgically resected bowel can predict the clinical outcome of these infants.

Study Design:

We reviewed the medical records and archived pathology specimens from all patients who underwent bowel resection/autopsy for NEC at a regional referral center over a 10-year period. Pathology specimens were graded for the depth and severity of necrosis, inflammation, bacteria invasion and pneumatosis, and histopathological findings were correlated with clinical outcomes.

Result:

We performed clinico-pathological analysis on 33 infants with confirmed NEC, of which 18 (54.5%) died. Depth of bacterial invasion in resected intestinal tissue predicted death from NEC (odds ratio 5.39 per unit change in the depth of bacterial invasion, 95% confidence interval 1.33 to 21.73). The presence of transmural necrosis and bacteria in the surgical margins of resected bowel was also associated with increased mortality.

Conclusion:

Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical NEC.

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Acknowledgements

This work was supported in part by the NIH award R01HD059142 (to AM).

Author contributions

AM, JIR, and SCA designed the study; JIR, SCA, SM, SAG and AM collected data; AAL and RR provided critical tools and expertise for data analysis; AM wrote the manuscript. All the authors reviewed and approved the final manuscript.

Author information

Author notes

  1. J I Remon and S C Amin: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA

    J I Remon, S C Amin & A Maheshwari

  2. The Lewis M. Fraad Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA

    J I Remon

  3. Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA

    S R Mehendale & S A Garzon

  4. Department of Pediatrics, Washington University at St Louis, St Louis, MO, USA

    R Rao

  5. Department of Pediatrics, University of South Florida, Tampa, FL, USA

    A A Luciano & A Maheshwari

  6. Department of Molecular Medicine, University of South Florida, Tampa, FL, USA

    A Maheshwari

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  1. J I Remon
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Corresponding author

Correspondence to A Maheshwari.

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Remon, J., Amin, S., Mehendale, S. et al. Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical necrotizing enterocolitis. J Perinatol 35, 755–762 (2015). https://doi.org/10.1038/jp.2015.51

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