title: Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis.
abstract: OBJECTIVE
  We hypothesized that neonates with bloody stools and concomitant eosinophilia are likely to have atopic enteropathy rather than necrotizing enterocolitis (NEC).
  
  
  METHODS
  This was a retrospective cross-sectional study using electronic medical records and paper charts. Records of neonates admitted to any Intermountain Healthcare NICU between 1 January 2005 and 30 June 2010 were eligible if 'bloody stools' were listed in any archive. Qualifying records were divided into two groups depending on whether or not within 72 h of passing bloody stool eosinophil counts were above the 95th percentile reference range limit for age.
  
  
  RESULTS
  Bloody stools were identified in 275 predominantly Caucasian neonates. Fifty-four of these had eosinophilia and 221 had normal eosinophil counts. Those with eosinophilia were born at a slightly younger gestational age (31.3 ± 4.6 vs 32.6 ± 4.0 weeks, mean ± s.d., P=0.032). Contrary to our hypothesis, those with eosinophilia did not have a lower rate of pneumatosis or bowel resection, or death ascribed to NEC. Eosinophilia was more common among those who had a red blood cell (RBC) transfusion within 48 h before passing bloody stools (P<0.001). Those with a recent RBC transfusion were the only neonates to have NEC surgery or to die from NEC. Preceding the bloody stools, those with no antecedent transfusion had been fed a larger volume (P=0.014), and had trends toward receiving calorically enriched feedings (P=0.055) and recent addition of human milk fortifier (P=0.060). Eosinophil counts following RBC transfusion tended to increase for 3-6 days, but when bloody stools were not preceded by transfusion the eosinophil counts were more static over that period.
  
  
  CONCLUSIONS
  In this predominantly Caucasian group of neonates with bloody stools, the presence of eosinophilia did not identify a benign condition distinct from NEC. A total of 44% of these neonates had transfusion-associated NEC. Eosinophils could have a previously unrecognized role in the pathogenesis of this NEC subtype.
authors.affiliation: Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT, USA. rdchris4@ihc.com
authors.forename: R D
authors.initials: RD
authors.lastname: Christensen
authors.forename: D K
authors.initials: DK
authors.lastname: Lambert
authors.forename: P V
authors.initials: PV
authors.lastname: Gordon
authors.forename: V L
authors.initials: VL
authors.lastname: Baer
authors.forename: E
authors.initials: E
authors.lastname: Gerday
authors.forename: E
authors.initials: E
authors.lastname: Henry
mesh_terms: D003430:Cross-Sectional Studies; D018450:Disease Progression; D020345:Enterocolitis, Necrotizing / Q000150:complications*; D004802:Eosinophilia / Q000150:complications*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D007410:Intestinal Diseases; D008297:Male; D009780:Occult Blood; D012189:Retrospective Studies