title: Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical necrotizing enterocolitis.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical NEC.
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.|The Lewis M. Fraad Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Remon
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Amin
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Mehendale
authors.affiliation: Department of Pediatrics, Washington University at St Louis, St Louis, MO, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rao
authors.affiliation: Department of Pediatrics, University of South Florida, Tampa, FL, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Luciano
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Garzon
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.|Department of Pediatrics, University of South Florida, Tampa, FL, USA.|Department of Molecular Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-1502-7663
authors.initials: A
authors.lastname: Maheshwari
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D058491:Bacterial Load / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007249:Inflammation; D007422:Intestines / Q000382:microbiology / Q000473:pathology; D008297:Male; D009336:Necrosis; D011237:Predictive Value of Tests