Standardising the elusive diagnosis of NEC in the premature infant - A practical score. (December 2022)

• Record Type: Journal Article
• Authors: Coles, Vanessa; Kortsalioudaki, Christina; Eaton, Simon; Curry, Joe; Aldeiri, Bashar; Fullerton, Lucy; Huertas, Angela
• Is Part Of: Early human development. Volume 175(2022)
• Publication Date: 2022-12
• Subjects: Necrotising enterocolitis -- NEC -- Preterm; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2022.105692
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Objective: The perceived risk of necrotising enterocolitis (NEC) can result in overtreatment of the otherwise adapting preterm neonate. We aim to develop an assessment tool to aid the decision making in the management of preterm neonates at risk of NEC. Method: An evidence-based assessment tool was designed bringing together clinical, laboratory and radiological signs commonly associated with NEC. A numerical score was awarded for each sign, with those more specific to NEC being graded higher. A multi-centre validation was conducted of the proposed assessment tool over three tertiary neonatal units. Results: A total of 125 patients were included, 53 (42.4 %) with a final diagnosis of NEC and 72 (57.6 %) with an alternative diagnosis. The NEC group had a significantly higher total score compared to the non-NEC group; 15(2–28) vs. 4(1–9) ( p ≤ 0.0001). In ROC analysis, using a cut-off of eight, the assessment tool gave a sensitivity of 92.3 % and a specificity of 90.4 % for identifying NEC compared to an alternative diagnosis. Conclusion: This comprehensive scoring system encourages a full assessment of the infant before deciding on withholding feeds, starting antibiotics, and transferring to a surgical centre. It is a safe objective measure to support a diagnosis of NEC in the presence of certain clinical signs. Highlights: The perceived risk of NEC can lead to over-diagnosis and treatment in the otherwise adapting neonate Currently no scoring system exists to aid decisions on stopping feeds and starting antibiotics in neonates We present a novel aid to guide clinical assessment and decision making in neonates with symptoms that could be due to NEC