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Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

Journal of Perinatology volume 32, pages 874–879 (2012)Cite this article

Subjects

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=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.

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.

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Authors and Affiliations

  1. Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT, USA

    R D Christensen, D K Lambert, V L Baer & E Henry

  2. Division of Neonatology, McKay-Dee Hospital Center, Ogden, UT, USA

    R D Christensen, D K Lambert & V L Baer

  3. Division of Neonatology, Department of Pediatrics, Tulane School of Medicine, New Orleans, LA, USA

    P V Gordon

  4. Division of Neonatology, Utah Valley Regional Medical Center, Provo, UT, USA

    E Gerday

  5. Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    E Henry

Authors
  1. R D Christensen
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  4. V L Baer
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Correspondence to R D Christensen.

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Christensen, R., Lambert, D., Gordon, P. et al. Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis. J Perinatol 32, 874–879 (2012). https://doi.org/10.1038/jp.2011.163

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