Pneumatosis coli: A benign form of necrotizing enterocolitis

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 > 34w while 82% of classic NEC cases were 6 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 groupprior 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 rol e of feeding practices) and to explore preventive or therapeutic measures.