INCREASE IN BILIRUBIN-ALBUMIN BINDING AFFINITY WITH CORRECTION OF NEONATAL ACIDOSIS

Abstract

Splanchnic ischemia is believed to be a major factor in the development of neonatal necrotizing enterocolitis (NEC). The role of vascular occlusion in the pathogenesis of NEC was studied in 30 autopsies. Multiple histologic sections of the mesentery were examined for the presence of thrombotic phenomena. Evidence of systemic thrombosis was also sought. 16 infants had a postmortem diagnosis of NEC (Group A) and 14 infants had intestinal hemorrhage or congestion (Group B). The clinical course of each patient was reviewed. 15/16 in Group A received oral feedings and 5/14 in Group B (P < .001).In Group A 12/15 had thromboemboli in mesenteric muscular arteries (TMA). 10/16 had evidence of multiple thromboemboli in other organs: kidney 7, adrenal 4, lung 4, and liver 2. 11/13 had mural thrombi of the abdominal aorta and iliac arteries. 15 had umbilical artery catheters (UAC) and 8 had umbilical venous catheters (UVC).In Group B 2/13 had TMA (P< .001). 11/14 had multiple thromboemboli in other organs: kidney 4, adrenal 3, lung 7, liver 2, and spleen 5. 9/12 had mural thrombi of the abdominal aorta and iliac arteries. 11 had UAC and 7 had UVC.There is an apparent association of NEC with meaenteric thromboembolism and oral feedings in this study.