Microbiological study correlated with pathological aspects of newborn enterocolitis

Camelia Budisan (1), Rodica Ilie (2), *Constantin Ilie (1), Enatescu Ileana (1), Mirabela Dima (1), Ioana Bortea (1), Cristina Moldovan (1)
(1) University of Medicine and Pharmacy, Neonatology, Timisoara, Romania; (2) Emergency Children Hospital, Pathology, Timisoara, Romania

Background We intended to determine the prevalence of the microbiological pathogens in necrotizing enterocolitis, correlated with the pathological aspects and abnormal pregnancy and birth signs, as an important neonatal death cause. Results

An important incidence of the enterocolitis among the total newborns with letal evolution in the studied period (7,33%). A great prevalence of the disease to the premature newborn 33,33%(9/27) - (Chart 1) and the age to the death (Table 2); In abnormal pregnancy and birth : maternal infections 11,74%; premature rupture membrane 18,61%; coloured amniotic liquid 26,56% ; APGAR less than 5 51,96% ; intensive therapy needed to birth 20,16%. The microbiological study revealed : Enterobacter 11,11%; Pyocianic 7,4%; Escherichia coli 3,7%; Staphilococus aureus 22,22%; Candida albicans 7,4%; Klebsiella 11,11% - (Chart 3); Pathological forms of the enterocolitis were : pyo-haemorrhagical 77,77%; haemorrhagical 22,22% (Fig. 1, 2); Pathological complications discovered were : peritonitis 29,62%; bowel perforation 14,81% - (Fig. 3, 4).
STUDY YEARS AGE OF THE NEWBORNS TO THE DEATH (DAYS) 1-7 3 4 2 1 8-14 2 2 1 1 15-21 1 1 22-30 1
11,11%
Enterobacter

Incidence of prematurity

Microbiological study

Pyocianic Escherichia coli Staphilococus aureus Candida albicans Klebsiella Unknown

Premature newborns
66.66 % 33.33 %

2004 2005 2006 2007 2008 2009 TOTAL

2 2 2 2

37,06%

7,40% 3,70%

22,22% 11,11% 7,40%

Chart 2 Microbiological study

10

Chart 1 Prematurity

Table 2 Age of the newborn

Fig.1 Classic findings of diffuse pyohaemorrhagical necrotizing enterocolitis

Fig. 2 Haemorrhagical necrotizing enterocolitis, with thrombosis of some loops

Fig. 3 H.E., x10. Destruction of villi, dilated capillary and inflammatory cells

Fig. 4 H.E., x20. Necrotizing peritonitis, with thrombosis and some areas of pneumatosis

Conclusions
We consider that in the Bell III necrotizing enterocolitis, the risk factors as: maternal infections during the pregnancy, prematurity, intensive therapy needs at birth, infectious factors, lead to hypoxia with bacterial migration from the intestinal lumen, inhibition of suppresor pathways, massive cytokines release with systemic sepsis and multiple organ failure. Necrotizing enterocolitis remains one of the most common emergencies for the newborn because of the usual complications : peritonitis and bowel perforation, leading to death.

References
1. Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003;6(1):6-23; 2. Henry MC, Lawrence Moss R. Surgical therapy for necrotizing enterocolitis: bringing evidence to the bedside. Semin Pediatr Surg 2005;14(3):181-90; 3. Lin PW, Stoll BJ. Necrotising enterocolitis. Lancet 2006;368(9543):1271-83.