MORPHOLOGICAL TRANSFORMATION OF THE INTESTINAL WALL IN NEWBORNS WITH NECROTISING ENTEROCOLITIS

Abstract

The purpose is to present morphological and morphometric changes in the histoarchitecture of the intestinal wall in newborns with necrotizing enterocolitis considering the outcomes of the disease. Materials and methods. The PRMU clinics carried out a morphological study of histological intestinal sections of 99 operated patients with NEC from 2003 to 2017. The patients were divided into the following groups: 72 survived newborns from group I (favourable outcome) and 27 dead newborns from group II (unfavourable outcome). The object under study was surgical specimen of the ileum and large intestine. Result. The disease outcome can be predicted using morphological changes in the intestinal wall in NEC. The leading role of the drainage function of the lymphatic apparatus is established in the article. It is completely restructured in the operational specimen of patients with the unfavourable course. Changes in the cellular composition in the form of insufficient number of fibroblast cells and isolated epithelial and stromal cells enabled subsequent destruction of the bowel wall with progression of the exudative processes.

Keywords

necrotizing enterocolitis / newborn / morphology / bowel

References

[1] 1. Lin P. W., Stoll B. J. Necrotising enterocolitis. J. Lancet. 2006; 368:1271–83. https://doi.org/10.1016/s0140–6736(06)69525–1

[2] 2. Blacely M. L. Postoperative outcomes in very-low-birth weight infants with necrotizing enterocolitis/ M. L. Blacely.J. Ann. Surg. 2005;241 (6):984–94. https://doi.org/10.1097/01.sla.0000164181.67862.7f

[3] 3. Henry C. W. Current issues in the management of necrotizing enterocolitis.J. Seminars in Perinatology. 2004; 28 (3):221–33

[4] 4. Подкаменев В. В. Язвенно-некротический энтероколит у новорожденных / Под ред. проф. В. В. Подкаменева, чл.‑кор. РАМН, проф. Е. Г. Григорьева. – М.: ОАО «Издательство «Медицина»; Иркутск: НЦРВХ СО РАМН, – 2010. – 244. – C. 163–170

[5] 5. Van Vliet E. O., de Kieviet J. F., Oosterlaan J., van Elburg R. M. Perinatal infections and neurodevelopmental outcome in very preterm and very low-birthweight infants: a meta-analysis. JAMA Pediatr. 2013;167:662–8, https://doi.org/10.1001/jamapediatrics.2013.1199

[6] 6. Merhar S. L., Ramos Y., Meinzen-Derr J., Kline-Fath B. M. Brain magnetic resonance imaging in infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation versus medical necrotizing enterocolitis.J. Pediatr. 2014;164:410. https://doi.org/10.1016/j.jpeds.2013.09.055

[7] 7. Strunk T., Inder T., Wang X. Y., Burgner D., Mallard C., Levy O. Infection-induced inflammation and cerebral injury in preterm infants.J. Lancet Infect Dis. 2014; 14:751–62. doi.org/10.1016/s1473–3099(14)70710–8

[8] 8. Gussenhoven R., Westerlaken R. J., Ophelders D., Jobe A. H., Kemp M. W., Kallapur S. G. Chorioamnionitis, neuroinflammation, and injury: timing is key in the preterm ovine fetus. J. Neuroinflammation. 2018;15:113. https://doi.org/10.1186/s12974-018-1149-x

[9] 9. Козлов Ю. А. Стриктуры кишечника у новорожденных после некротизирующего энтероколита (пост-нэк стриктуры кишечника)/ Ю. А. Козлов, К. А. Ковальков, Д. М. Чубко, П. Ж. Барадиева, А. Д. Тимофеев, Г. П. Ус, Н. Н. Кузнецова//Детская хирургия. – Издательство: «Медицина» Москва, – 2016. – Т.20. – № 6. – c.228–234

[10] 10. Муратов И. Д. Послеоперационный перитонит у новорожденных. Проблемы диагностики и лечения/ И. Д. Муратов // Детская хирургия. – 2006. – № 1. – c. 46–48

[11] 11. Ионушене С. В., Красовская Т. В., Новожилов В. А., Кикина Е. И. Хирургические осложнения некротического энтероколита у новорожденных детей: патогенетическое обоснование путей профилактики// Детская хирургия – 2004. – № 2. – c. 15–198

[12] 12. Smith P. L., Hagberg H., Naylor A. S., Mallard C. Neonatal peripheral immune challenge activates microglia and inhibits neurogenesis in the developing murine hippocampus. J. Dev Neurosci. 2014; 36:119–31. https://doi.org/10.1159/000359950

[13] 13. Zonis S., Pechnick R. N., Ljubimov V. A., Mahgerefteh M., Wawrowsky K., Michelsen K. S. Chronic intestinal inflammation alters hippocampal Neurogenesis. J. Neuroinflammation. 2015;12:65. doi.org/10.1186/s12974-015-0281-0

[14] 14. Vinther A. M., Heegaard P. M., Skovgaard K., Buhl R., Andreassen S. M., Andersen P. H. Characterization and differentiation of equine experimental local and early systemic inflammation by expression responses of inflammation-related genes in peripheral blood leukocytes. J. BMC Vet Res. 2016;12:83, doi.org/10.1186/s12917-016-0706-8

[15] 15. Hartel C., Hartz A., Pagel J., Rupp J., Stein A., Kribs A. NOD2 loss-of-function mutations and risks of necrotizing enterocolitis or focal intestinal perforation in very low-birth-weight infants. J. Inflamm Bowel Dis. 2016. 22 (2):249–56, doi: 10.1097/MIB.0000000000000658

[16] 16. Holman R. C., Stool B. J., Curns A. T., Yorita K. L., Steiner C. A. Necrotizing enterocolitis hospitalizations among neonates in the United States. J. Pediatr Perinat.Epidemiol. 2006;20:111–124, doi:10.1111/j.1365–3016.2006.00756.x

[17] 17. Gribble F. M., Reimann F. Enteroendocrine cells: chemosensors in the intestinal epithelium. J. Annu Rev Physiol. 2016;78:277–99. doi.org/10.1146/annurev-physiol-021115–105439

[18] 18. Sampath V., Menden H., Helbling D., Li. K., Gastonguay A., Ramchandran R. SIGIRR genetic variants in premature infants with necrotizing enterocolitis. J. Pediatrics. 2015;135 (6):e1530–4, https://doi.org/10.1542/peds.2014–3386

[19] 19. Elgin T. G., Kern S. L., McElroy S. J. Development of the neonatal intestinal microbiome and its association with necrotizing enterocolitis. J. Clin Ther2016; 38 (4):706–15, doi: 10.1016/j.clinthera.2016.01.005

[20] 20. Vongbhavit K., Underwood M. A. Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant. J. Clin Ther. 2016; 38 (4):716–32, doi: 10.1016/j.clinthera.2016.01.006

[21] 21. Ионушене С. В. Клинико-морфологическое обоснование патогенеза и тактики лечения некротизирующего энтероколита у новорожденных детей: дис. на соиск.учен.степ.канд.мед.наук. – М., – 2002. – с.124

[22] 22. Черпалюк Е. А. Особенности хирургической тактики при некротическом энтероколите у детей: дис. на соиск.учен. степ.канд.мед.наук. – Тюмень, – 2005. ‑с.118

[23] 23. Balance W. A., Dahms B. B., Shenker N. Pathology of neonatal necrotizing enterocolitis: a ten year experience. J. Pediatrics. 1990;117: S6 – S13. doi.org/10.1016/s0022–3476(05)81124–2.

RIGHTS & PERMISSIONS

Karpova I.Y., Parshikov V.V., Shirokova N.Y., Pyatova Е.D., Molchanova D.V., Bebenina A.A.