A critical evaluation of current definitions of necrotizing enterocolitis

Lueschow, Shiloh R.; Boly, Timothy J.; Jasper, Elizabeth A.; Patel, Ravi; McElroy, Steven J.

doi:10.1038/s41390-021-01570-y

Cited by 19 publications

(16 citation statements)

References 18 publications

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“…Other definitions have been proposed to further standardise the NEC definition, but these are not widely used yet [ 22 ]. This may be because newer definitions have better specificity, but a lower sensitivity compared to the Bell’s criteria [ 23 ]. Recent attempts were made to use artificial intelligence to define NEC and differentiate between NEC and SIP, with various algorithms accurately differentiating between NEC and SIP and performing better than traditionally used definitions [ 23 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…This may be because newer definitions have better specificity, but a lower sensitivity compared to the Bell’s criteria [ 23 ]. Recent attempts were made to use artificial intelligence to define NEC and differentiate between NEC and SIP, with various algorithms accurately differentiating between NEC and SIP and performing better than traditionally used definitions [ 23 – 26 ]. However, all studies were done on relatively small, single-centre groups, and attempts with larger datasets are expected in the near future.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Development of an international core outcome set for treatment trials in necrotizing enterocolitis—a study protocol

Klerk

Varsseveld

Offringa

et al. 2023

Trials

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Aim Necrotizing enterocolitis (NEC) is the most lethal disease of the gastrointestinal tract of preterm infants. New and existing management strategies need clinical evaluation. Large heterogeneity exists in the selection, measurement, and reporting of outcome measures in NEC intervention studies. This hampers meta-analyses and the development of evidence-based management guidelines. We aim to develop a Core Outcome Set (COS) for NEC that includes the most relevant outcomes for patients and physicians, from moment of diagnosis into adulthood. This COS is designed for use in NEC treatment trials, in infants with confirmed NEC. Methods This study is designed according to COS-STAD (Core Outcome Set-STAndards for Development) recommendations and the COMET (Core Outcome Measures in Effectiveness Trials) Initiative Handbook. We obtained a waiver from the Ethics Review Board and prospectively registered this study with COMET (Study 1920). We will approach 125 clinicians and/or researchers from low-middle and high-income countries based on their scientific output (using SCIVAL, a bibliometric tool). Patients and parents will be approached through local patient organisations. Participants will be separated into three panels, to assess differences in priorities between former patients and parents (1. lay panel), clinicians and researchers involved in the neonatal period (2. neonatal panel) and after the neonatal period (3. post-neonatal panel). They will be presented with outcomes currently used in NEC research, identified through a systematic review, in a Delphi process. Eligible outcome domains are also identified from the patients and parents’ perspectives. Using a consensus process, including three online Delphi rounds and a final face-to-face consensus meeting, the COS will be finalised and include outcomes deemed essential to all stakeholders: health care professionals, parents and patients’ representatives. The final COS will be reported in accordance with the COS-Standards for reporting (COS-STAR) statement. Conclusions Development of an international COS will help to improve homogeneity of outcome measure reporting in NEC, will enable adequate and efficient comparison of treatment strategies, and will help the interpretation and implementation of clinical trial results. This will contribute to high-quality evidence regarding the best treatment strategy for NEC in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development of an international core outcome set for treatment trials in necrotizing enterocolitis—a study protocol

Klerk

Varsseveld

Offringa

et al. 2023

Trials

View full text Add to dashboard Cite

show abstract

“…Defining NEC remains an enigma and 8 different definitions have been proposed 40 , but none are considered satisfactory. Definitions attempt to define distinct entities and what we term “NEC” today is not a distinct entity 41 , thus is not readily amenable to a definition.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…Patient family perspectives are key in accelerating our efforts to integrate newer diagnostic methods into practice 42 . At the very least, we are beginning to recognize that the Bell staging criteria are not optimal and better criteria are needed 40 .…”

Section: Clinical Applicationsmentioning

confidence: 99%

Multiomics, artificial intelligence, and precision medicine in perinatology

2022

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Technological advances in omics evaluation, bioinformatics and artificial intelligence have made us rethink ways to improve patient outcomes. Collective quantification and characterization of biological data including genomics, epigenomics, metabolomics and proteomics is now feasible at low cost with rapid turnover. Significant advances in the integration methods of these multi-omics datasets by machine learning promises us a holistic view of disease pathogenesis and yield biomarkers for disease diagnosis and prognosis. Using machine learning tools and algorithms, it is possible to integrate multiomics data with clinical information to develop predictive models that identify risk before the condition is clinically apparent, thus facilitating early interventions to improve the health trajectories of the patients. In this review, we intend to update the readers on the recent developments related to the use of artificial intelligence in integrating multiomic and clinical datasets in the field of Perinatology, focusing on neonatal intensive care and the opportunities for precision medicine. We intend to briefly discuss the potential negative societal and ethical consequences of using artificial intelligence in healthcare. We are poised for a new era in medicine where computational analysis of biological and clinical datasets will make precision medicine a reality.

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“…8 However, comparison of several current definitions has shown that the modified Bell's classification is not specific for NEC. 9,10 Multiple disorders need to be differentiated from NEC, including protein-mediated enterocolitis and spontaneous intestinal perforation. 1 Findings at surgery, pathology, or autopsy may help differentiate NEC from other entities such as spontaneous intestinal perforation in case of pneumoperitoneum.…”

mentioning

confidence: 99%

Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

Nayak,

Sánchez-Rosado,

Reis

et al. 2024

Am J Perinatol

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Background: No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, i.e., with an area under the curve (AUC) ≥ ≥ 0.9, which preterm infants will undergo surgery for NEC stage III or die within a week. Methods: This is a retrospective cohort study (n=261) of preterm infants <33 weeks' gestation or <1500 grams birthweight with either suspected or with definite NEC born at Parkland Hospital between 2009-2021. A prediction model using the new HASOFA score [Hyperkalemia, Hyperglycemia, use of inotropes for Hypotension during the prior week, Acidemia, neonatal Sequential Organ Failure Assessment (nSOFA) score] was compared with a similar model using the nSOFA score. Results: Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA score and the nSOFA score were evaluated in 254 and 253 infants, respectively, at the time of the initial work up for NEC. Both models were internally validated. The HASOFA-model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA-model, with greater AUC 0.909 vs 0.825, respectively, P<0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively. Conclusion: Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC.

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A critical evaluation of current definitions of necrotizing enterocolitis

Cited by 19 publications

References 18 publications

Development of an international core outcome set for treatment trials in necrotizing enterocolitis—a study protocol

Development of an international core outcome set for treatment trials in necrotizing enterocolitis—a study protocol

Multiomics, artificial intelligence, and precision medicine in perinatology

Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

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