The prognostic value of a risk score for necrotising enterocolitis

Abstract

Necrotising enterocolitis is the most common severe acquired gastrointestinal disorder in the neonate yet there remains disagreement on predictive and prognostic factors. A previously published risk score purports to predict infants at greater risk of the disease. Fifty-nine cases and 59 matched controls were evaluated using data from the first 24 h after birth to determine the predictive and prognostic value of the score for necrotising enterocolitis. In simple models the risk score was significantly, but inversely, associated with necrotising enterocolitis, primarily due to greater respiratory problems among controls. This finding contrary to the premise is clarified by a significant interaction of the risk score with feeding variables. Odds ratios for the risk score varied at different levels of daily feeding increments. However, the risk score was not statistically significant in any models which controlled for feeding increment and the interaction. The risk score was significantly associated with mortality among necrotising enterocolitis cases. Though the score was not statistically significant when the outcome was disease stage or surgery, trends were in the expected direction. The data suggest that the risk score itself may not be an independent predictor of necrotising enterocolitis, but may indicate infants more vulnerable to other potential risk factors and, in addition, may be related to prognosis for those who do develop necrotising enterocolitis.

Prevention and Early Recognition of Necrotizing Enterocolitis

“…Overall, testing of the NRS was incomplete, confounded by feeding issues that impact NEC risk, and underpowered to detect significant effects. 55,56 An updating of NEC risk assessment scoring is warranted.…”

Early prediction of severity of necrotizing enterocolitis in preterm infants: A composite scoring tool

“…The diagnostic parameters used for creating the predictive scoring tool to define NEC severity were chosen from common clinical symptoms and signs associated with suspicion of NEC [12][13][14][15][20][21][22][23][24][25] and are summarized in Table 1. The scoring tool consisted of clinical presentation, radiological and laboratory findings, feeding characteristics and gastric residuals.…”

“…[12] Similarly, McKeown et al identified clinical parameters such as respiratory changes immediately preceding a diagnosis of NEC. [15] However, these tools do not include a composite of clinical, laboratory or radiological parameters in their scoring system that are temporally related to the time before NEC is suspected, as the purpose for these tools was for prediction of occurrence of NEC, rather than the predicting of disease severity. Early prediction of NEC severity would allow early aggressive management of at-risk infants by withholding feeds and initiation of broad-spectrum antibiotics.…”

“…[12][13][14][15] Gephart et al developed GutCheck, a tool used to predict the occurrence of NEC based on evaluating several known risk factors, including gestational age (GA), history of blood transfusions, sepsis, metabolic acidosis and human milk feeding. [12] Similarly, McKeown et al identified clinical parameters such as respiratory changes immediately preceding a diagnosis of NEC.…”