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).Study Design: 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.Result: 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 ¼ 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 ¼ 0.014), and had trends toward receiving calorically enriched feedings (P ¼ 0.055) and recent addition of human milk fortifier (P ¼ 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. Conclusion: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. Keywords: necrotizing enterocolitis; bloody stools; eosinophilia; RBC transfusion; transfusion-associated NEC; atopic enteropathy Introduction Eosinophilia is diagnosed when the concentration of eosinophils in the blood exceeds the upper reference range limit. 1 Until recently, this upper limit was not well defined for neonates, allowing imprecision in defining eosinophilia and in identifying associations between it and various clinical conditions. Using laboratory values from over 63 000 neonates we recently reported the 5th and 95th percentile values for blood eosinophil concentrations at various gestational and postnatal ages. 2 The 95th percentile upper limit ranges from 1180 eosinophils ml À1 in the first week to about 1560 ml À1 after 3 weeks. 2 Given this more precise definition of neonatal eosinophilia, we commenced the present study of the association between bloody stools and eosinophilia.When bloody stools are observed in a neonate, the possibility of necrotizing enterocolitis (NEC) enters the ...

Haematological abnormalities in neonatal necrotizing enterocolitis

“…Christensen et al (30) noted eosinophilia in 54 of 275 infants (19.6%) who were evaluated for bloody stools. They hypothesized that premature infants with bloody stools and eosinophilia were likely to have atopic enteropathy and not develop the classical signs of NEC, and were therefore, more likely to have a benign course of disease.…”

Immunologic and Hematological Abnormalities in Necrotizing Enterocolitis

“…144 Christensen et al 147 noted eosinophilia in 54 of 275 infants (19.6%) who were evaluated for bloody stools. They hypothesized that premature infants with bloody stools and eosinophilia were likely to have atopic enteropathy and not develop the classical signs of NEC, and were therefore, more likely to have a benign course of disease.…”

Early Persistent Blood Eosinophilia in Necrotizing Enterocolitis Is a Predictor of Late Complications

“…1) [5, 10, 23]. Some investigators have suggested eosinophilia and bloody stools identify the onset of NEC presenting <48 hours after a blood transfusion [24], but TANEC in our infants did not necessarily have early persistent eosinophilia and/or bloody stools (table 3). In surgical specimens, the intestinal mucosa of subjects with eosinophilia and NEC had ulcers possibly related to sub-epithelial fibrosis.…”

“…Previously, researchers had proposed eosinophilia as a white blood cell-related biomarker for the onset of NEC [24]. Moreover, fibrotic disease of the gut and liver are major causes of organ injury, and today physicians have a better understanding of the pathogenesis and prevention of fibrosis [26].…”