Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000

Table 1 Different definitions of neutropenic enterocolitisamong studies

Neutropenic enterocolitis definition	Neutropenia (Neutrophil count/mm3)	Abnormal bowel wall thickness thresholds (imaging technique)	Ref.
Neutropenia in addition to fever and abdominal pain (generalized or localized to right lower quadrant) without any other obvious cause of abdominal discomfort	< 500	Not specified	Jain et al[26], 2000
Al least 1 suggestive clinical sign (fever, abdominal tenderness, diarrhea, nausea, emesis, abdominal pain, and/or constipation) associated with bowel wall thickness ≥ 0.3 cm	< 500	≥ 0.3 cm (either CT or US; CT and US findings were significantly different)	McCarville et al[42], 2005
Abdominal pain, fever, and neutropenia associated with radiological abnormalities in the terminal ileum and/or ascending colon (comprising increased wall thickness, pericecal edema, pneumatosis intestinalis)	< 1000	Not specified (CT)	Hobson et al[51], 2005
Recent abdominal pain (global or right lower quadrant), fever and severe neutropenia in absence of prior abdominal discomfort	< 500	> 5 mm (US and CT)	Alioglu et al[24], 2007
One or more of clinical signs (fever, abdominal pain, diarrhea, abdominal tenderness, nausea, emesis, and/or evidence of peritonitis) and one or more imaging findings on US, CT, x-ray (bowel wall thickening, bowel edema, relative paucity of bowel gas, bowel mass, thumb printing of the mucosa or air in the bowel wall)	< 500	Not specified (x-ray or US or CT)	Moran et al[54], 2009
Clinical triad (abdominal pain, fever and neutropenia) or 2 clinical features with thickened bowel wall in imaging	< 1.65	Not specified (US or CT)	Mullassery et al[23], 2009
1 or more signs and/or symptoms related to the effects of treatment (abdominal pain, abdominal distention, vomiting, diarrhea, fever defined as TC ≥ 38 °C, gastrointestinal bleeding, or obstipation) associated with increased intestinal wall thickness in US	≤ 500	≥ 3 mm (US)	Rizzatti et al[22], 2010
Clinical triad (abdominal pain, high fever and neutropenia) associated with the evidence of image signs (thickened bowel wall) by abdominal US or CT scan	< 500	> 4 mm (US or CT)	Li et al[40], 2011
Fever (TC > 38.5 °C), abdominal pain, neutropenia associated with radiologically confirmed thickening of the bowel wall	< 500	> 3 mm (CT and US concordant)	Sundell et al[38], 2012
Clinical triad (abdominal pain, fever and neutropenia) or 2 clinical features with thickened bowel wall in imaging	< 500	> 5 mm (US/CT)	Altinel et al[39], 2012
Proposed diagnostic criteria:			Sachak et al[175], 2015
Major criteria
Compatible histology
At least borderline neutropenia
Gastrointestinal symptoms
Immunosuppression
Recent chemotherapy
Exclusion of other treatable etiologies
Minor criteria
Fever of > 38 °C
Bowel wall thickening of > 4 mm over > 30 mm
Positive microbiologic studies
“Definitive” NE satisfies the major criteria

US: Ultrasonography; CT: Computed tomography.

Table 2 Clinical, laboratory and imaging factors associated with severe neutropenic enterocolitis

Factor	Outcome	Ref.
Previous therapy with cytarabine	Higher death rate	Rizzatti et al[22], 2010
Age > 16 yr	Worse response to medical therapy	McCarville et al[42], 2005
Presence of abdominal distention	Higher risk of death	Rizzatti et al[22], 2010
Presence of abdominal tenderness	Prolonged duration	McCarville et al[42], 2005
Presence of fever	Prolonged duration	McCarville et al[42], 2005
4 or more symptoms of enterocolitis	Higher risk of death	Rizzatti et al[22], 2010
Severe (absolute neutrophil count < 108/L) or prolonged (> 7 d) neutropenia	Disease progression	Jain et al[26], 2000
Duration of neutropenia	Prolonged duration	McCarville et al[42], 2005
Increased serum Interleukin-8 levels on the first day of clinical illness	Higher risk of admission in Intensive Care Unit	van de Wetering et al[55], 2008
Bowel wall tickness	Prolonged duration	Sundell et al[38], 2012
	Higher mortality rate	Cartoni et al[57], 2001
	Higher death rate	Rizzatti et al[22], 2010
	Prolonged duration	McCarville et al[42], 2005
Appendiceal thickening	Higher risk of serious complications	McCarville et al[56], 2004