THE INCONSISTENCY OF CLINICAL AND HISTOLOGICAL DIAGNOSIS IN NEONATES WITH NECROTIZING ENTEROCOLITIS.

Despite decades of active research, the exact cause (etiology) and pathogenesis of Neonatal Necrotizing Enterocolitis (NEC) remains unknown. The mechanism of disease development and the progression of intestinal injury remain areas of ongoing research and controversy. NEC is a major cause of mortality and significant morbidity, often in premature infants with an inverse relationship to gestation, and may occur uncommonly in term infants. Despite advances in neonatal intensive care, its incidence, morbidity and mortality has remained unchanged. NEC remains a major concern for neonatologists, pediatric surgeons and gastroenterologists due to its high morbidity and mortality. The etiology and pathogenesis of NEC remain controversial. The classic histological finding is coagulation necrosis present in over 90% of specimens. With NEC, \the most commonly affected areas are the terminal ileum and the proximal ascending colon. The pattern of disease may involve a single isolated area or multiple discontinuous lesions. The most common histologic findings are associated with mucosal injury. These include coagulation necrosis of the mucosa with active and chronic inflammation, mucosal ulceration, edema, hemorrhage, and pneumatosis of the submucosa. The clinical presentation of NEC is nonspecific, broad and includes variable symptoms which are often nonspecific signs of gastrointestinal dysfunction. The aim of the study is to compare the histological (autopsy) and clinical data in neonates with necrotizing enterocolitis. The retrospective study was performed to assess and compare histological (autopsy) and clinical data among newborns with necrotizing enterocolitis over 2016-2017 periods -- born in 21 deliveries hospitals, newborns admitted to NICU of "Muratsan" clinical complex of Yerevan State Medical University aft. M. Heratsi and autopsy data of medical centre "Arabkir". In 73 (86.9% out of 84 cases) newborns the NEC was diagnosed during autopsy and histological examination. The histological diagnose NEC matched with referral diagnose in 27 cases -- 37% (out of 73 cases). In 46 (63% out of 73 newborns) cases NEC was present during autopsy and histological examination, but didn't manifested clinically or was not diagnosed before death. In other findings 42 cases out of 142 lethal newborns during the autopsy the histological signs of different stages of NEC were detected, but were not included in clinical diagnose. The results of our study denote that a high proportion of the incompatibilities of NEC diagnosis can be attributed to diagnostic limitations and are potentially avoidable with the use of modern diagnostic technics. [ABSTRACT FROM AUTHOR]