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Am J Perinatol
DOI: 10.1055/a-2483-5736
Review Article

Bedside Utilization of Intestinal Pathology in Preterm Infants with Surgical Necrotizing Enterocolitis

Padma P. Garg
1   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Victoria G. Weis
2   Wake Forest Institute for Regenerative Medicine, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Jeffrey Shenberger
3   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
,
Jared A. Weis
4   Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Anna McDonald
5   Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Parvesh M. Garg
6   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
› Author Affiliations
Funding P.M.G. is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number U54GM115428 and the department of pediatrics at Wake Forest School of Medicine.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with multiorgan dysfunction, multiple systemic morbidities, and mortality. The resected bowel commonly shows evidence of coagulative necrosis, inflammation, interstitial hemorrhages, and reparative changes on the pathology examination. The severity of these pathological abnormalities may correlate with the disease's severity and pace of progression and may assist in the prediction of clinical outcomes. This review presents current evidence about the clinical utility of intestinal pathology in bedside decision-making, accurate diagnosing, prediction of outcomes, and the prognostication of preterm infants with surgical NEC. Developing refined and validated noninvasive methods to diagnose the extent of bowel injury and monitoring tissue repair throughout disease progression is paramount to mitigate the long-term morbidities in preterm infants with surgical NEC. Improved imaging methods such as targeted bowel ultrasound capable of assessing the inflammation and necrosis in real time will greatly advance care and provide focus for the temporal framework of surgical interventions.

Key Points

  • The degree and severity of intestinal pathological changes are associated with different outcomes.

  • Bedside utilization of the intestinal pathological changes may help improve outcomes.

  • Targeted noninvasive methods to diagnose the extent of bowel injury in real time are greatly needed.

Keywords

neonate - surgical NEC - histology - outcomes

Authors' Contributions

P.M.G. conceptualized the idea. P.P.G., V.G.W., J.A.W., A.M., J.S., and P.M.G. wrote and approved the manuscript.




Publication History

Received: 28 August 2024

Accepted: 22 November 2024

Accepted Manuscript online:
25 November 2024

Article published online:
24 December 2024

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