Hematologic Abnormalities in Severe Neonatal Necrotizing Enterocolitis: 25 Years Later

Abstract

Necrotizing enterocolitis (NEC), the most common surgical emergency in newborns, remains a therapeutic challenge for clinicians. The hematological manifestations associated with NEC were first described 25 years ago. This review discusses current knowledge of the pathophysiology involved in disturbances in megakaryocytopoiesis, coagulation, leukopoiesis, and erythropoiesis that accompany the clinical entity NEC. The discussion includes current understanding of and potential strategies for treating the hematopoietic disturbances that occur secondary to NEC.

A simple presurgical necrotizing enterocolitis-mortality scoring system

“…The lower leukocyte counts we found in surgically treated infants as well as in Bell stage III (P ¼ 0.05) are in keeping with previous findings. 3,12,13 However, neither in the present study nor in another study by Voss et al 14 of infants with a mean GA of 31 weeks, were there differences in leukocyte count between survivors and non-survivors. However, in more mature infants with NEC, low leukocyte counts were associated with increased mortality.…”

Low blood neutrophil concentrations among extremely low birth weight neonates: data from a multihospital health-care system

“…These varieties of neonatal neutropenia are well described. 2,20,[22][23][24][25] However, we found that 43% of the late-onset cases had no recognized underlying cause. Some of these might have been the benign variety of neutropenia sometimes termed, 'idiopathic neutropenia of prematurity'.…”

Thrombocytopenia related neonatal outcome in preterms

“…6,18,22 and the associated morbidity due to sepsis. 10,11,23 have been previously reported in populations of more mature neonates. Moreover, the autonomous role of thrombocytopenia in the development of IVH has been also questioned by other studies.…”

“…19 Moreover, the efficacy of platelet transfusions in the reduction of the adverse neonatal outcome is still questionable. 10,18 Uncertainness regarding the riskbenefit ratio of platelet transfusions demonstrates the need for studies that will help in the development of appropriate strategies for the management of thrombocytopenia in very preterm born neonates. However, the high risk of bleeding in non-transfused preterm infants and platelet transfusion-associated complications, 19,20 restricts the interventional design for research in this field.…”