Affiliations: College of Medicine, The Ohio State University,
Columbus, OH, USA
Note: [] Corresponding author: Leandro Cordero, M.D., Division of
Neonatal-Perinatal Medicine, The Ohio State University Medical Center,
Department of Pediatrics, N118 Doan Hall, 410 W. 10th Avenue, Columbus, OH
43210-1228, USA. Tel.: +1 614 293 8660; Fax: +1 614 293 7676; E-mail:
Leandro.cordero@osumc.edu
Abstract: Background: Recently, we observed an increase in the number of late
preterm neonates with pneumatosis coli (Pcoli) an infrequently reported benign
form of necrotizing enterocolitis (NEC). Objective: To review our
experience (2000–09) with infants who presented with visible blood in the
stools (VBS) and pneumatosis intestinalis (PI). Methods: Retrospective cohort study. There were 65~infants who had VBS and PI. Thirty-two who
constituted the pneumatosis coli (Pcoli) group were compared with 33 infants
with VBS and PI who were designated as classic NEC. Results: 75% of
Pcoli cases occurred during 2008–09. Demographics and obstetrical risk factors
(except for preterm labor and antepartum steroid use) for the mothers of both
groups were similar. Ninety-one percent of Pcoli were $\geq $ 34w while 82%
of classic NEC cases were ⩽ 33w GA. At the time of diagnosis 70% of
infants in the Pcoli group and 30% of those in the classic NEC group were
< 7d old. In the Pcoli group prior to VBS, 78% of these infants
were taking formula and 22% formula and breast milk. VBS was the only
clinical sign which prompted radiographic evaluation. Thirty of these
32 infants had blood cultures (all negative), 20% received antibiotics,
50% continued with feedings, no patients had surgery and all survived.
In the classic NEC group prior to VBS 47% were taking formula, 47%
formula and breast milk and 6% breast milk. Seventy-four percent of these
infants had abdominal distention, emesis or apnea, 48% had abnormal
WBC-diff, and 6 infants had positive blood cultures. Ten infants had surgery
and 3 of them expired. Among Pcoli infants, PI was limited to the colon in
94% of the cases. In the classic NEC group 35% of infants had difuse PI,
65% had focal PI and 27% had portal venous gas. Conclusion: Pcoli is a benign form of NEC that affects mainly late preterm or term infants, who
once diagnosed, in contrast to classic NEC patients, require less intensive
care. Further studies are needed to elucidate etiology (including the role of
feeding practices) and to explore preventive or therapeutic measures.
Keywords: Pneumatosis coli, benign necrotizing enterocolitis, late preterm infant
