Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

Abstract

Objective: Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.Study Design: This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.Result: Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52). Conclusion:Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.

Intestinal trefoil factor increased the Bcl-2 level in a necrotizingenterocolitis neonate rat model

“…However, the surgery can cause short bowel syndrome and inadequate absorption of nutrients. Thus, better therapeutic measures are needed (6,7). Studies have indicated that the scores for neonatal acute physiology-perinatal extension-II and metabolic derangement acuity were insufficient measures for deciding on surgical treatment for the patients affected by NEC (8).…”

Risk factors for necrotizing enterocolitis totalis: a case–control study

“…In 2008, Moss et al 17 attempted to delineate clinical predictors of NEC in a multi-institutional study. A total of 455 infants were evaluated prospectively.…”

“…[8][9][10][11][12][13] Various studies have been undertaken to elucidate risk factors for the development of NEC. [14][15][16][17][18] The two most commonly observed risk factors appear to be prematurity and enteral feeding. The use of breast milk may be a protective factor.…”

Doppler ultrasound assessment of the splanchnic circulation in preterms with neonatal sepsis at risk for necrotizing enterocolitis

“…Although the exact etiology of necrotizing enterocolitis (NEC) remains unknown, researchers suggest that it is multifactorial. Prematurity (with an immature GIT and immature host defenses) is the primary risk factor [3]; ischemia and/or reperfusion injury, exacerbated by the activation of proinflammatory intracellular cascades, may play a significant role [4]. Neonatal sepsis is considered a risk factor for NEC [5].…”