The pathogenesis of ischemic gastroenterocolitis of the neonate: Selective gut mucosal ischemia in asphyxiated neonatal piglets

• Published in: Journal of pediatric surgery Vol. 7; no. 2; pp. 194 - 205
• Main Authors: Touloukian, Robert J., Posch, John N., Spencer, Richard
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.1972
• Subjects: Animals; Animals, Newborn; Asphyxia Neonatorum - complications; Blood Flow Velocity; Cardiovascular Diseases - complications; Disease Models, Animal; Enterocolitis, Pseudomembranous - etiology; Enterocolitis, Pseudomembranous - pathology; Humans; Infant, Newborn; Infant, Newborn, Diseases - etiology; Intestinal Mucosa - blood supply; Intestinal Mucosa - pathology; Intestinal Perforation - etiology; Ischemia; Regional Blood Flow; Respiratory Distress Syndrome, Newborn - complications; Resuscitation; Swine
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/0022-3468(72)90496-4

Necrotizing enterocolitis and intestinal perforation, occurring without distal obstruction of the gastrointestinal tract, are serious lesions of the neonatal period. The onset of gastrointestinal findings is often preceded by severe postnatal stress, usually of cardiorespiratory origin, producing hypoxemia, hypercarbia, and systemic acidosis. Resuscitated infants, usually premature, remain clinically well during a latent period until they develop characteristic signs of enterocolitis, including gastric retention, bile vomitus, abdominal distension and blood streaked, diarrheal stools. Hemorrhagic and necrotic lesions, with or without perforation, are most commonly found in the stomach, ileum, or colon at operation and/or autopsy. The pattern of asphyxia, resuscitation, and a latent period followed by gastrointestinal findings has been the subject of much speculation about the causal relationship of cardiorespiratory distress in infants with necrotizing enterocolitis. The temporal relationship of perinatal asphyxia to the acute onset of gastroenterocolitis is summarized on Fig. 1. An experimental model was designed that simulates conditions of postnatal respiratory distress and allows measurement of intramural and mucosal perfusion to the gut of asphyxiated and resuscitated neonatal piglets, as well as histologic studies of the gut. We suggest that the term “ischemic gastroenterocolitis of the neonate” be adopted to best describe this condition.