Purpose: Intestinal failure is a recognised complication following treatment of necrotizing enterocolitis (NEC) in infants. The adaptability of the remaining intestine has an impact on the successful weaning from parenteral nutrition (PN).Our aim was to report 1) immunological profile and  2) macroscopic and microscopic intestinal endoscopic findings among infants who developed IF secondary to NEC.

 

Materials and Methods:We obtained ethical approval to retrospectively review infants with a diagnosis of Bell stage II or III NEC who were consecutively admitted and treated in our unit (2005-2011) and subsequently developed IF. IF was defined according to national guidelines as requirement of parenteral nutrition (PN) >27 days. Infants with IF were managed by a multidisciplinary team led by Paediatric Gastroenterologists who performed the endoscopies based on individualised patient’s clinical needs.

 

Results:During the study period, 33 (23%) out of 148 infants with NEC developed IF. Of 11 (33%) infants [6 (54%) female] with IF who had 15 endoscopy sessions, results were available from 13 sessions.At endoscopy (n=13), macroscopic abnormalities were detected in 5/13 (39%) endoscopies however 9/13 (70%) had microscopic abnormalities on histology. Macroscopic abnormalities were mainly erythema in duodenum (n=2) and colon (n=2); and mucosal contact bleeding (n=1). Microscopic abnormalities were gastro-duodenitis (n=3), duodenitis (n=2), duodenal sub-total villous atrophy (n=1), duodenal intraepithelial lymphocytosis (n=1), increased lamina propria and eosinophil density (n=1) and colitis (n=1). Immunoglobulin profiles (a total of 9 tests from four infants) were: total IgA 0.65 (0.3-0.92), IgM 0.97 (0.59-1.57), IgG 6.72 (3.72-7.45) and IgE 22.4 (3.0-86.7). 8/12 blood IgA levels and 4/9 IgM were borderline low 4/9 blood IgE levels were raised. Overall, 3/33 (9%) infants with IF died, one of these underwent endoscopy.

 

Conclusion:  A third of infants with IF secondary to NEC require endoscopy; a majority of these (70%) have microscopic abnormalities even in the absence of macroscopic abnormalities. Although no patient had a major immunodeficiency low levels of blood IgA and IgM were common. An enteropathy should be considered in infants who are slow to wean from PN treatment and endoscopy with biopsies performed.