Clinical determinants and impact of hemorrhagic lesions on intestinal pathology in preterm infants with surgical necrotizing enterocolitis.

Autor: Garg PM; Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Denton MX; Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Talluri R; Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA., Ostrander MM; Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Middleton C; Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Sonani H; Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Varshney N; Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA., Hillegass WB; Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA.; Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Jazyk: angličtina
Zdroj: Journal of neonatal-perinatal medicine [J Neonatal Perinatal Med] 2023; Vol. 16 (1), pp. 119-128.
DOI: 10.3233/NPM-221116
Abstrakt: Objective: We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC).
Methods: A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology.
Results: The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 %; p = 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p = 0.034), lost more bowel length (p = 0.045), had higher CRP levels at 2 weeks (p = 0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; p = 0.014) than mild/moderate (Grade 0-2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; p = <0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; p = 0.037), higher neovascularization (p = 0.01), higher fibroblasts (p = 0.023) and higher lymphocyte percentages up to 48 hours (p < 0.05) following NEC than mild/ moderate hemorrhage group.On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05-0.58]; p = 0.005), higher inflammation (OR 3.7 [95% CI 2.09-7.32]; p = 0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02-1.11]; p = 0.005) were independently associated with a higher odd of severe intestinal hemorrhage.
Conclusion: The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling.
Databáze: MEDLINE
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