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.

Introduction

Necrotizing enterocolitis (NEC) continues to be a leading cause of morbidity and mortality in premature infants. 1, 2 Although approximately one-half of all infants with NEC respond to bowel rest, antibiotics and supportive medical measures, many develop progressive bowel disease requiring surgical intervention. 3 In the sub-group of infants with NEC who require surgery, up to half may undergo laparotomy and require resection of necrotic bowel. In this study, we investigated the hypothesis that the histopathological findings in intestinal tissue resected for NEC could be useful to the clinician in predicting the clinical outcome of these infants.