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The role of ischemia in necrotizing enterocolitis.
Chen, Yong; Chang, Kenneth Tou En; Lian, Derrick Wen Quan; Lu, Hao; Roy, Sudipto; Laksmi, Narasimhan Kannan; Low, Yee; Krishnaswamy, Gita; Pierro, Agostino; Ong, Caroline Choo Phaik.
Afiliación
  • Chen Y; Department of Pediatric Surgery, KK Women's & Children's Hospital, Singapore.
  • Chang KT; Department of Pathology, KK Women's & Children's Hospital, Singapore.
  • Lian DW; Department of Pathology, KK Women's & Children's Hospital, Singapore.
  • Lu H; Institute of Molecular and Cell Biology, Singapore.
  • Roy S; Institute of Molecular and Cell Biology, Singapore.
  • Laksmi NK; Department of Pediatric Surgery, KK Women's & Children's Hospital, Singapore.
  • Low Y; Department of Pediatric Surgery, KK Women's & Children's Hospital, Singapore.
  • Krishnaswamy G; Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
  • Pierro A; Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto.
  • Ong CC; Department of Pediatric Surgery, KK Women's & Children's Hospital, Singapore. Electronic address: caroline.ong.cp@kkh.com.sg.
J Pediatr Surg ; 51(8): 1255-61, 2016 Aug.
Article en En | MEDLINE | ID: mdl-26850908
AIM: The role of ischemia in the pathogenesis of necrotizing enterocolitis (NEC) remains unclear. We used immunohistochemical markers of hypoxia to identify presence/absence of ischemia in NEC and spontaneous intestinal perforation (SIP) with clinical correlation. METHODS: Immunohistochemical staining was performed on 24 NEC and 13 SIP intestinal resection specimens using 2 hypoxia markers, hypoxia inducible factor 1α (HIF-1α) and glucose transporter 1 (GLUT1) and inflammatory markers, leukocyte common antigen (LCA) and myeloperoxidase. Ischemic score (0-6) from the sum of the HIF-1α and GLUT1 staining intensity grades was devised (positive ≥3). Inflammation was graded from the sum of LCA and myeloperoxidase grading. Relevant clinical information was obtained from hospital case records. RESULTS: Fourteen NEC specimens had positive ischemic score (4.6±1.2). The remaining 10 NEC (ischemic score 0.7±0.8) and all 13 SIP samples (ischemic score 0.5±0.5) were ischemic-negative. The ischemic-positive cases had classic NEC with multiple areas of bowel necrosis; were associated with later onset, enteral feeding and pneumatosis. In contrast, all ischemic-negative NEC were short-segment NEC with perforation. Their clinical profile was similar to the SIP cases with younger gestational age at birth, early onset, association with ibuprofen/indomethacin usage but not with feeding and pneumatosis. Ischemic scores are correlated with inflammation scores in mucosa but not submucosa. CONCLUSIONS: Ischemia as assessed with immunohistochemical markers HIF-1α and GLUT1, has a primary role in pathogenesis of classic NEC only, not in SIP or short-segment NEC with perforation. Better categorization of the different types of NEC can direct appropriate prevention and treatment strategies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enterocolitis Necrotizante / Isquemia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies Límite: Humans / Infant / Newborn Idioma: En Revista: J Pediatr Surg Año: 2016 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enterocolitis Necrotizante / Isquemia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies Límite: Humans / Infant / Newborn Idioma: En Revista: J Pediatr Surg Año: 2016 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Estados Unidos