OUTCOME AND DETERMINANTS OF NEUTROPENIC ENTEROCOLITIS IN PEDIATRIC
CANCER PATIENTS
Abstract
Background Neutropenic enterocolitis (NEC) is a dreaded complication of
chemotherapy. There is scant literature regarding incidence, clinical
features, and determinants. The understanding of gut dysbiosis in NEC
and pediatric cancer is evolving. Methods Pediatric cancer patients with
neutropenia and gastrointestinal symptoms were evaluated for NEC with
CECT abdomen. Clinical, imaging, and laboratory features were analysed.
Fecal samples were analysed for fecal calprotectin by sandwich ELISA and
gut microbiota by conventional culture and compared with healthy
controls and children without NEC. Results NEC was diagnosed in 44
children based on clinical and imaging features with incidence of 7.4%
(Four had recurrent episodes). Common manifestations included
fever(98%), pain abdomen(88%), and diarrhoea(83%). Hypoalbuminemia
was observed in 78% patients. Large bowel involvement(94%) with
diffuse bowel involvement(63%) and pancolitis(64%) were common. Fecal
calprotectin was significantly elevated in NEC group than non-NEC group
and healthy controls (median 87, 53, and 42 µg/g respectively). Higher
degree of gut dysbiosis was observed in children with NEC with higher
isolation of Bacteroides and infrequent isolation of Lactobacilli..
Mortality rate of 23% was observed. Only presence of free fluid
predicted higher mortality. Though levels of fecal calprotectin and gut
dysbiosis were higher in NEC, they didn’t increase mortality. Isolation
of Bacteroides and absence of Lactobacilli predicted longer duration of
intravenous alimentation. Conclusion NEC caused significant morbidity
and mortality in pediatric cancer patients. Gut dysbiosis was
significantly higher in NEC group suggesting role in pathogenesis and
influencing outcome. This highlights role of targeted interventions
towards gut dysbiosis like prebiotics and probiotics.