Are Scores Reliable in Predicting the Need for Surgery and Mortality in Necrotizing Enterocolitis?

Arni, Delphine; Karam, Oliver; Vidal, Isabelle; Rimensberger, Peter C.; Hanquinet, Sylviane; Wildhaber, Barbara E.

doi:10.1055/s-0036-1593382

Cited by 9 publications

(10 citation statements)

References 23 publications

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“…It affects 5-14% of infants weighing o1,500g (1). Among common neonatal gastrointestinal urgencies, NEC is highly lifethreatening, with a high mortality if not treated in due course (2)(3)(4)(5)(6). So far, the etiology of NEC is still multifactorial (7,8).…”

Section: ' Introductionmentioning

confidence: 99%

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Gao

Mao

et al. 2021

Clinics

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OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

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Section: ' Introductionmentioning

confidence: 99%

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Gao

Mao

et al. 2021

Clinics

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“…Some authors have designed scores to help clinicians with the diagnostic process [7,8,9]. However, there is a low concordance between these tests [14]. Furthermore, these diagnostic criteria focus on diagnosing NEC and not on excluding it to avoid overtreatment.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Necrotizing Enterocolitis: An International Survey of Neonatologists and Pediatric Surgeons

et al. 2017

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Background: Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies. Objectives: To evaluate the parameters used to diagnose or exclude NEC, and to identify differences between neonatologists and pediatric surgeons. Methods: A scenario-based survey was sent to neonatologists and pediatric surgeons. Results: 173 physicians from 26 countries completed the survey (55% neonatologists and 45% pediatric surgeons). Bloody stools, abdominal tenderness, low platelet counts, and increased lactate levels increased the likelihood of NEC for 82, 72, 56, and 45% of respondents, respectively. Intestinal pneumatosis, portal venous gas, and pneumoperitoneum on X-ray increased the likelihood of NEC for 99, 98, and 92% of respondents, respectively. Clinical examination and laboratory tests were insufficient to exclude NEC, but normal intestinal movements and normal gut wall thickness on ultrasonography decreased the likelihood of NEC for 38 and 33% of respondents, respectively. Neonatologists more frequently relied on increased gastric residuals and abdominal distension to diagnose NEC (p = 0.04 and p = 0.03, respectively), whereas pediatric surgeons more frequently reported that absence of bloody stools helped to exclude NEC (p = 0.04). In a deteriorating patient with suspected NEC, 39% of respondents would broaden the antibiotic spectrum, and 42% would recommend a laparotomy. Conclusion: Our results indicate a wide variation in the management of NEC, with significant differences between neonatologists and pediatric surgeons. A better appreciation of the relative significance and weighting that should be applied to the clinical features and investigations should reduce the variation in interpretation that appears to exist.

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“…Necrotizing enterocolitis (NEC) is an acute condition predominantly affecting preterm neonates that necessitates surgical procedures in up to 50% of the patients. [12][13][14] Our aim was to evaluate postoperative opioid use and methadone use in infants with surgically treated NEC, identify hospitallevel variations in methadone use, and examine postoperative outcomes for infants receiving methadone.…”

Section: Introductionmentioning

confidence: 99%

Opioid and Methadone Use for Infants With Surgically Treated Necrotizing Enterocolitis

et al. 2023

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ImportanceNecrotizing enterocolitis (NEC) requiring surgical intervention is the most common reason for surgical procedures in preterm neonates. Opioids are used to manage postoperative pain, with some infants requiring methadone to treat physiologic opioid dependence or wean from nonmethadone opioid treatment during recovery.ObjectiveTo describe postoperative opioid use and methadone treatment for infants with surgically treated NEC and evaluate postoperative outcomes.Design, Setting, and ParticipantsA cohort study of infants with surgically treated NEC admitted from January 1, 2013, to December 31, 2022, to 48 Children’s Hospital Association hospitals contributing data to the Pediatric Health Information System (PHIS) was performed. Infants who received methadone preoperatively, were aged 14 days or less at the time of the operation, had a congenital heart disease–related operation, or died within 90 days of the operation were excluded. Mixed-effects multivariable logistic regression was used to evaluate thresholds for duration of opioid use after the operation associated with methadone treatment and clinical outcomes associated with methadone use were enumerated.ExposurePostoperative administration of nonmethadone opioids.Main Outcomes and MeasuresMethadone use and postoperative length of stay, ventilator days, and total parenteral nutrition (TPN) days.ResultsOf the 2037 infants with surgically treated NEC identified, the median birth weight was 920 (IQR, 700.0-1479.5) g; 1204 were male (59.1%), 911 were White (44.7%), and 343 were Hispanic (16.8%). Infants received nonmethadone opioids for a median of 15 (IQR, 6-30) days after the operation and 231 received methadone (11.3%). The median first day of methadone use was postoperative day 18 (IQR, days 9-64) and continued for 28 days (IQR, 14-73). Compared with infants who received nonmethadone opioids for 1 to 5 days, infants receiving 16 to 21 days of opioids were most likely to receive methadone treatment (odds ratio, 11.45; 95% CI, 6.31-20.77). Methadone use was associated with 21.41 (95% CI, 10.81-32.02) more days of postoperative length of stay, 10.80 (95% CI, 3.63-17.98) more ventilator days, and 16.21 (95% CI, 6.34-26.10) more TPN days.Conclusions and RelevanceIn this cohort study of infants with surgically treated NEC, prolonged use of nonmethadone opioids after the operation was associated with an increased likelihood of methadone treatment and increased postoperative length of stay, ventilation, and TPN use. Optimizing postoperative pain management for infants requiring an operation may decrease the need for methadone treatment and improve health care use.

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Are Scores Reliable in Predicting the Need for Surgery and Mortality in Necrotizing Enterocolitis?

Cited by 9 publications

References 23 publications

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Diagnosis and Management of Necrotizing Enterocolitis: An International Survey of Neonatologists and Pediatric Surgeons

Opioid and Methadone Use for Infants With Surgically Treated Necrotizing Enterocolitis

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