Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge

Abstract

We found poor validity for the discharge diagnosis of necrotising enterocolitis. In future, a better way of defining the disease is needed for large-scale epidemiologic research.

Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

“…The mortality rate in the group of infants who were under diagnosed, meaning the infants were not diagnosed with NEC at discharge but by a retrospective expert panel, was 50.0%, while the mortality rate in the overdiagnosed group, where the infants were diagnosed with NEC at discharge but not by the retrospective expert panel, was 28.5%. This indicates that the NEC diagnosis at discharge had a false low mortality compared to the actual NEC mortality rate . Another contributing factor to the variety in mortality between studies could be due to the policies regarding withdrawal of active treatment in different parts of the world .…”

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

“…Suspected NEC was defined as “the presence of systemic manifestations (temperature instability, lethargy, apnea, and bradycardia), gastrointestinal manifestations (poor feeding, increasing pregavage residuals, emesis, mild abdominal distension, and occult blood in stool), and abdominal radiographs showing distension with mild ileus.” These criteria were chosen as they were felt to be important but were not based on any solid evidence. Furthermore, these signs are nonspecific and are regularly challenged [12,13]. Some authors have designed scores to help clinicians with the diagnostic process [7,8,9].…”

Staging of necrotising enterocolitis by Bell's criteria is supported by a statistical pattern analysis of clinical and radiological variables

“…KJD is the code for surgery on the stomach or duodenum. Spontaneous intestinal perforation did not have a separate code in our system, but is normally classified as NEC stage III in our department . To minimise missing data, we excluded infants presenting with NEC for the first time during re‐admission (Fig.…”

“…The preterm infant population has changed since 1978 due to survival of the smallest infants and Bell's staging system has also been criticised for its poor validity and for not separating NEC from other diseases, most importantly spontaneous intestinal perforation . Other ways of classifying NEC have been suggested, including two that use specific criteria based on gestational age , but they have not yet gained ground.…”