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Paediatric Pathology Online

Pathology of Neonatal Necrotizing Enterocolitis

Dr Sampurna Roy MD





Neonatal Necrotizing Enterocolitis (NNEC) has become increasingly common and usually affects small preterm infants, in particular those weighing less than 2000g.

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It is usually apparent during the first 2 weeks of life.

Pneumatosis intestinalis is the radiological hallmark.

The pathogenesis of NNEC is still incompletely understood,but factors recognized include mucosal ischemia, oral feeding and bacterial colonization of the bowel lumen.

The condition has also been described folllowing exchange transfusion, umbilical arterial catheterization, cardiac catheterization and blood hyperviscosity.

The terminal ileum and proximal colon are affected most commonly.

Gas blebs may be visible beneath the serosa.

Microscopic features are related to the stage and severity of the disease. 

Initially there is edema, hemorrhage, coagulation, necrosis, inflammation and pneumatosis.

Subsequently,there is epithelial regeneration, granulation formation and fibrosis, the latter often found associated with luminal stenosis. 


Further reading:

Pathogenesis of neonatal necrotizing enterocolitis.

The use of laboratory biomarkers for surveillance, diagnosis and prediction of clinical outcomes in neonatal sepsis and necrotising enterocolitis 

Pathology of neonatal necrotizing enterocolitis: a ten-year experience.

Gastric residuals and their relationship to necrotizing enterocolitis in very low birth weight infants.

The incidence of necrotizing enterocolitis after introducing standardized feeding schedules for infants between 1250 and 2500 grams and less than 35 weeks of gestation.

[Necrotizing enterocolitis: a 12-year retrospective study].



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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