O.H. Radhika Krishna1, Mohammed Abdul Aleem2, Mandakini Kotaiah3, Ramesh Reddy Kota4
BACKGROUND
Neonatal necrotising enterocolitis (NNEC) is very common among premature
infants. However, its incidence in term babies has also been on the rise. It is a
potentially devastating condition with variable mortality. The diagnosis and
management of NNEC is clinically supported by modified Bell’s grading. In cases
where surgical resection of bowel is performed, histological findings are rarely
given much importance. In this study, we have studied the histopathology of
resected bowel in NNEC in term babies and correlated these findings with the age
of the neonate and also with modified Bell’s grading.
METHODS
25 cases of small bowel specimens of term infants received at the pathology
department of a tertiary paediatric referral hospital were studied in detail for gross
and microscopic features. The histological parameters considered were transmural
coagulative necrosis, granulation tissue, crypt distortion, pseudomembrane
formation, villous atrophy and pneumatosis intestinalis. These findings were
compared with the age of the neonates and also correlated with the modified Bell’s
grading. The clinical presentation and histology were also compared in early
presenting term neonates less than a week in age and term infants of more than
a week.
RESULTS
We found early neonates of age less than a week to have higher Bell’s grading
and more severe histology.
CONCLUSIONS
Term neonates also present with severe NNEC, requiring surgical resection of the
bowel. Early presentation and higher Bell’s grading are associated with more
severe histopathological changes.
